Healthcare Provider Details

I. General information

NPI: 1194419762
Provider Name (Legal Business Name): BABAK BEHMARDI KALANTARI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 11/19/2023
Certification Date: 11/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11015 OLSON DR STE 6
RANCHO CORDOVA CA
95670-5654
US

IV. Provider business mailing address

4024 LOWDAN CT
ROSEVILLE CA
95747-7449
US

V. Phone/Fax

Practice location:
  • Phone: 916-635-7798
  • Fax: 916-636-0344
Mailing address:
  • Phone: 714-936-1767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number36434
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: