Provider Demographics
NPI:1982764569
Name:MIRSHOJAE, ALIREZA (DC)
Entity type:Individual
Prefix:MR
First Name:ALIREZA
Middle Name:
Last Name:MIRSHOJAE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21731 VENTURA BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-5116
Mailing Address - Country:US
Mailing Address - Phone:818-674-0326
Mailing Address - Fax:818-510-0182
Practice Address - Street 1:21731 VENTURA BLVD STE 215
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-5116
Practice Address - Country:US
Practice Address - Phone:818-674-0326
Practice Address - Fax:818-510-0182
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC22086OtherLICENCE NUMBER
CAU37110Medicare UPIN