Healthcare Provider Details

I. General information

NPI: 1871651976
Provider Name (Legal Business Name): ADVANCED CHIROPRACTIC SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17777 VENTURA BLVD STE 120 #120
ENCINO CA
91316-3738
US

IV. Provider business mailing address

17777 VENTURA BLVD STE 120 #120
ENCINO CA
91316-3738
US

V. Phone/Fax

Practice location:
  • Phone: 818-654-8320
  • Fax: 818-654-8321
Mailing address:
  • Phone: 818-654-8320
  • Fax: 818-654-8321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC24277
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number24277
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number24277
License Number StateCA

VIII. Authorized Official

Name: MRS. MAHNAZ AZIMZADEH
Title or Position: DOCTOR/OWNER
Credential: D.C
Phone: 818-501-5553