Provider Demographics
NPI:1568292324
Name:AZIZI-SHAHBA CHIROPRACTIC
Entity type:Organization
Organization Name:AZIZI-SHAHBA CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER/ PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHBA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-912-8070
Mailing Address - Street 1:1111 BAKER ST STE E
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4138
Mailing Address - Country:US
Mailing Address - Phone:949-800-8665
Mailing Address - Fax:
Practice Address - Street 1:1111 BAKER ST STE E
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4138
Practice Address - Country:US
Practice Address - Phone:949-800-8665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty