Healthcare Provider Details

I. General information

NPI: 1821101148
Provider Name (Legal Business Name): JAMES THOMAS IWANOFF D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30423 CANWOOD ST SUITE 225
AGOURA HILLS CA
91301-2082
US

IV. Provider business mailing address

30423 CANWOOD ST SUITE 225
AGOURA HILLS CA
91301-2082
US

V. Phone/Fax

Practice location:
  • Phone: 818-797-2225
  • Fax: 818-991-9070
Mailing address:
  • Phone: 818-707-2225
  • Fax: 818-991-9070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC13558
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: