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General NPI Number Information
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NPI Number | 1023943065
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Entity Type | Individual
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Provider Name | MAKSIM IGOREVICH ISHANKHANOV
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Gender | Male
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Dates
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Enumeration Date | 06/12/2026
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Last Update Date | 06/12/2026
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Provider Practice Location Address
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Address Line | 175 E OLIVE AVE STE 200
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City | BURBANK
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State | CA
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Zip | 91502-1821
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Country | US
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Telephone | 213-932-0630
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Fax |
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Provider Business Mailing Address
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Address Line | 11733 AVON WAY APT 101
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City | LOS ANGELES
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State | CA
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Zip | 90066-7224
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Country | US
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Telephone | 213-932-0630
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 35207
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License Number State | CA
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