Healthcare Provider Details

I. General information

NPI: 1942852520
Provider Name (Legal Business Name): VAZIN CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29050 S WESTERN AVE STE 152
RANCHO PALOS VERDES CA
90275-0812
US

IV. Provider business mailing address

28827 LEAH CIR
RANCHO PALOS VERDES CA
90275-4767
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: MR. SAM VAZIN
Title or Position: OWNER
Credential: DC
Phone: 310-519-8877