Healthcare Provider Details

I. General information

NPI: 1780600437
Provider Name (Legal Business Name): MINOO SEDEHIZADEH DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 CENTRAL VALLEY HWY
SHAFTER CA
93263-2790
US

IV. Provider business mailing address

PO BOX 1060 655 CENTRAL VALLEY HWY
SHAFTER CA
93263-2790
US

V. Phone/Fax

Practice location:
  • Phone: 661-459-1927
  • Fax: 661-459-1974
Mailing address:
  • Phone: 661-459-1900
  • Fax: 661-459-1974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number25798
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: