Healthcare Provider Details

I. General information

NPI: 1003418062
Provider Name (Legal Business Name): FARDAD MOGHARABI CHIROPRACTIC SERVICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4426 E. VILLAGE RD
LONG BEACH CA
90808-1536
US

IV. Provider business mailing address

4426 E. VILLAGE RD
LONG BEACH CA
90808-1536
US

V. Phone/Fax

Practice location:
  • Phone: 562-354-6900
  • Fax: 562-354-6902
Mailing address:
  • Phone: 562-354-6900
  • Fax: 562-354-6902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MR. FARDAD MOGHARABI
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 562-354-6900