Healthcare Provider Details

I. General information

NPI: 1982926218
Provider Name (Legal Business Name): MARJAN KHORRAMI CHIROPRACTIC WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23412 MOULTON PKWY STE 120
LAGUNA HILLS CA
92653-1743
US

IV. Provider business mailing address

23412 MOULTON PKWY STE 120
LAGUNA HILLS CA
92653-1743
US

V. Phone/Fax

Practice location:
  • Phone: 949-770-0128
  • Fax: 949-829-0221
Mailing address:
  • Phone: 949-770-0128
  • Fax: 949-829-0221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-31376
License Number StateCA

VIII. Authorized Official

Name: DR. MARJAN KHORRAMI
Title or Position: OWNER
Credential: D.C.
Phone: 949-770-0128