Healthcare Provider Details

I. General information

NPI: 1891197034
Provider Name (Legal Business Name): KUPELIAN CHIROPRACTIC HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 S GLENDALE AVE
GLENDALE CA
91205-3349
US

IV. Provider business mailing address

1332 S GLENDALE AVE
GLENDALE CA
91205-3349
US

V. Phone/Fax

Practice location:
  • Phone: 818-484-8901
  • Fax: 818-484-8902
Mailing address:
  • Phone: 818-484-8901
  • Fax: 818-484-8902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number32680
License Number StateCA

VIII. Authorized Official

Name: DR. ASDGHIK STAR KUPELIAN
Title or Position: CEO
Credential: D.C
Phone: 18184848901