Healthcare Provider Details

I. General information

NPI: 1457338980
Provider Name (Legal Business Name): MANSOUR TAFRESHI CHIRO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 BROCKTON AVE SUITE 108
RIVERSIDE CA
92501
US

IV. Provider business mailing address

4121 BROCKTON AVE STE 108
RIVERSIDE CA
92501-3442
US

V. Phone/Fax

Practice location:
  • Phone: 949-355-4222
  • Fax:
Mailing address:
  • Phone: 949-355-4226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC24004
License Number StateCA

VIII. Authorized Official

Name: DR. MANSOUR TAFRESHI
Title or Position: CEO
Credential: DC
Phone: 949-355-4226