Healthcare Provider Details

I. General information

NPI: 1992029946
Provider Name (Legal Business Name): IWANOFF CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 04/05/2010
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: 818-707-2225
  • 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: DR. JAMES THOMAS IWANOFF
Title or Position: PRESIDENT
Credential: D.C.
Phone: 818-707-2225