Healthcare Provider Details

I. General information

NPI: 1114107901
Provider Name (Legal Business Name): DARRICK E SAHARA DC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E WALNUT ST SUITE 130
PASADENA CA
91101-1585
US

IV. Provider business mailing address

221 E WALNUT ST SUITE 130
PASADENA CA
91101-1585
US

V. Phone/Fax

Practice location:
  • Phone: 626-796-6830
  • Fax: 626-796-6950
Mailing address:
  • Phone: 626-796-6830
  • Fax: 626-796-6950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number28999
License Number StateCA

VIII. Authorized Official

Name: DR. DARRICK E. SAHARA
Title or Position: CHIROPRACTIC KINESIOLOGIST
Credential: DC
Phone: 626-796-6830