Provider Demographics
NPI:1396281572
Name:SORAYA WELLNESS CHIROPRACTIC INC.
Entity type:Organization
Organization Name:SORAYA WELLNESS CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CROUCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-595-4326
Mailing Address - Street 1:6101 W CENTINELA AVE
Mailing Address - Street 2:SUITE 290
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6337
Mailing Address - Country:US
Mailing Address - Phone:213-595-4326
Mailing Address - Fax:
Practice Address - Street 1:6101 W CENTINELA AVE
Practice Address - Street 2:SUITE 290
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6337
Practice Address - Country:US
Practice Address - Phone:213-595-4326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty