Healthcare Provider Details

I. General information

NPI: 1023503679
Provider Name (Legal Business Name): NATURE HEALTH CHIRO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29050 S WESTERN AVE STE 152
RANCHO PALOS VERDES CA
90275
US

IV. Provider business mailing address

PO BOX 53486
IRVINE CA
92619-3486
US

V. Phone/Fax

Practice location:
  • Phone: 310-519-8877
  • Fax: 310-519-8290
Mailing address:
  • Phone: 310-519-8877
  • Fax: 310-519-8290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number33876
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18047
License Number StateCA

VIII. Authorized Official

Name: GHAZALEH MONICA MAHMOUDI
Title or Position: OWNER
Credential: DC. LAC
Phone: 310-519-8877