Provider Demographics
NPI:1992039713
Name:KHADEMI, MEHDI (DC)
Entity type:Individual
Prefix:
First Name:MEHDI
Middle Name:
Last Name:KHADEMI
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 1:453 E ARROW HWY
Mailing Address - Street 2:A
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-5612
Mailing Address - Country:US
Mailing Address - Phone:626-859-6460
Mailing Address - Fax:626-859-6463
Practice Address - Street 1:453 E ARROW HWY
Practice Address - Street 2:A
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-5612
Practice Address - Country:US
Practice Address - Phone:626-859-6460
Practice Address - Fax:626-859-6463
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor