Healthcare Provider Details

I. General information

NPI: 1457673840
Provider Name (Legal Business Name): BALAKHANI S CHIROPRACTIC PROFESSIONAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11645 WILSHIRE BLVD # 745
LOS ANGELES CA
90025-6800
US

IV. Provider business mailing address

11645 WILSHIRE BLVD # 745
LOS ANGELES CA
90025-1708
US

V. Phone/Fax

Practice location:
  • Phone: 310-888-8802
  • Fax: 310-696-0700
Mailing address:
  • Phone: 310-488-8880
  • Fax: 310-696-0700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC26604
License Number StateCA

VIII. Authorized Official

Name: DR. SHAHRAM BALAKHANI
Title or Position: OWNER
Credential: D.C
Phone: 310-888-8802