Healthcare Provider Details

I. General information

NPI: 1720931157
Provider Name (Legal Business Name): KHADEMI CHIROPRACTIC PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 WILSHIRE BLVD STE 1501
LOS ANGELES CA
90010-1608
US

IV. Provider business mailing address

3250 WILSHIRE BLVD STE 1501
LOS ANGELES CA
90010-1608
US

V. Phone/Fax

Practice location:
  • Phone: 213-291-0505
  • Fax:
Mailing address:
  • Phone: 213-291-0505
  • Fax:

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: TANIN KHADEMI
Title or Position: OWNER
Credential: DC
Phone: 213-291-0505