MEDICARE: FARAHANCHI CHIROPRACTIC CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC25862	CA

General Provider Information

NPI Number	:	1104317882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARAHANCHI CHIROPRACTIC CORPORATION

Provider Business Mailing Address
First Line	:	2883 MEADE AVE STE B
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-4211
Country	:	US
Telephone Number	:	619-298-2342
Fax Number	:	619-298-7215

Provider Business Practice Location Address
First Line	:	2883 MEADE AVE STE B
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-4211
Country	:	US
Telephone Number	:	619-298-2342
Fax Number	:	619-298-7215

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALI FARAHANCHI
Credential	:	D.C.
Telephone Number	:	619-298-2342

Provider Enumeration Date	:	05/29/2018
Last Update Date	:	05/29/2018

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