Provider Demographics
NPI:1841624384
Name:CHLDRYAN, RUBEN G (DC)
Entity type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:G
Last Name:CHLDRYAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:RUBEN
Other - Middle Name:
Other - Last Name:CHLDRIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:6235 MAMMOTH AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY GLEN
Mailing Address - State:CA
Mailing Address - Zip Code:91401-2919
Mailing Address - Country:US
Mailing Address - Phone:818-237-6602
Mailing Address - Fax:
Practice Address - Street 1:600 W BROADWAY
Practice Address - Street 2:SUITE 125
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1022
Practice Address - Country:US
Practice Address - Phone:818-237-6602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-31
Last Update Date:2013-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32702111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic