Healthcare Provider Details

I. General information

NPI: 1093897746
Provider Name (Legal Business Name): DEVAKHSHESH CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 S ROBERTSON BLVD # 1
LOS ANGELES CA
90035-1505
US

IV. Provider business mailing address

1016 S ROBERTSON BLVD # 1
LOS ANGELES CA
90035-1505
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-9283
  • Fax:
Mailing address:
  • Phone: 310-652-9283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number25524273
License Number StateCA

VIII. Authorized Official

Name: ALFRED A DERAKHSHESH
Title or Position: CHIROPRACTOR (PRESIDENT)
Credential:
Phone: 310-652-9293