Provider Demographics
NPI:1487912655
Name:NAZEMI CHIROPRACTIC CORP.
Entity type:Organization
Organization Name:NAZEMI CHIROPRACTIC CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ALYECE
Authorized Official - Last Name:NAZEMI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-773-3400
Mailing Address - Street 1:74000 COUNTRY CLUB DR STE A5
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-1677
Mailing Address - Country:US
Mailing Address - Phone:760-773-3400
Mailing Address - Fax:760-771-3200
Practice Address - Street 1:74000 COUNTRY CLUB DR STE A5
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-1677
Practice Address - Country:US
Practice Address - Phone:760-773-3400
Practice Address - Fax:760-771-3200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAZEMI CHIROPRACTIC CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-25
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32245111N00000X
CA32276111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGF049AOtherMEDICARE PTAN