Provider Demographics
NPI:1386781599
Name:MNATSAKANIAN, GOAR (DC)
Entity type:Individual
Prefix:DR
First Name:GOAR
Middle Name:
Last Name:MNATSAKANIAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 W GLENOAKS BLVD
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-1930
Mailing Address - Country:US
Mailing Address - Phone:818-548-8028
Mailing Address - Fax:818-548-8106
Practice Address - Street 1:1540 W GLENOAKS BLVD
Practice Address - Street 2:SUITE # 103
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-1930
Practice Address - Country:US
Practice Address - Phone:818-548-8028
Practice Address - Fax:818-548-8106
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor