Healthcare Provider Details

I. General information

NPI: 1619281581
Provider Name (Legal Business Name): MICHAEL NADERI CHIROPRACTIC CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 WILSHIRE BLVD SUITE 221
LOS ANGELES CA
90010-1120
US

IV. Provider business mailing address

3020 WILSHIRE BLVD SUITE 221
LOS ANGELES CA
90010-1120
US

V. Phone/Fax

Practice location:
  • Phone: 213-385-4535
  • Fax: 213-385-0204
Mailing address:
  • Phone: 213-385-4535
  • Fax: 213-385-0204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL NADERI
Title or Position: PRESIDENT
Credential: D.C.
Phone: 213-385-4535