Provider Demographics
NPI:1992991830
Name:GARY TCHOBANIAN CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:GARY TCHOBANIAN CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:TCHOBANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:323-663-6664
Mailing Address - Street 1:2950 LOS FELIZ BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-1501
Mailing Address - Country:US
Mailing Address - Phone:323-663-6664
Mailing Address - Fax:323-663-6695
Practice Address - Street 1:2950 LOS FELIZ BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-1501
Practice Address - Country:US
Practice Address - Phone:323-663-6664
Practice Address - Fax:323-663-6695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W17873Medicare PIN