MEDICARE: LILIT AVETYAN 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1275053423	OTHER	CA	NPI

General Provider Information

NPI Number	:	1457815904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILIT AVETYAN CHIROPRACTIC CORPORATION

Provider Business Mailing Address
First Line	:	401 S GLENOAKS BLVD STE 108
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91502-2707
Country	:	US
Telephone Number	:	818-433-7339
Fax Number	:	818-433-7341

Provider Business Practice Location Address
First Line	:	401 S GLENOAKS BLVD STE 108
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91502-2707
Country	:	US
Telephone Number	:	818-433-7339
Fax Number	:	818-433-7341

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. LILIT AVETYAN
Credential	:	DC
Telephone Number	:	818-433-7339

Provider Enumeration Date	:	01/29/2019
Last Update Date	:	02/06/2019

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