Healthcare Provider Details

I. General information

NPI: 1780924779
Provider Name (Legal Business Name): ELINA ADIBI DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2013
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 S ROBERTSON BLVD
LOS ANGELES CA
90035-1505
US

IV. Provider business mailing address

1016 S ROBERTSON BLVD
LOS ANGELES CA
90035-1505
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-9283
  • Fax: 310-652-9292
Mailing address:
  • Phone: 310-652-9283
  • Fax: 310-652-9292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberA658490
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: