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General NPI Number Information
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NPI Number | 1093172603
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Entity Type | Organization
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Legal Business Name | VICTOR SADEGHI MALVAJERDI CHIROPRACTIC
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Dates
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Enumeration Date | 01/27/2016
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Last Update Date | 01/27/2016
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Provider Practice Location Address
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Address Line | 3540 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90010
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Country | US
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Telephone | 213-480-3190
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Fax | 213-480-3188
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Provider Business Mailing Address
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Address Line | 11734 WILSHIRE BLVD 1314
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City | LOS ANGELES
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State | CA
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Zip | 90025
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Country | US
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Telephone | 310-456-4389
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Fax | 213-480-3188
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. VICOTR S MALVEJERDI
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Credential | DC
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Telephone | 310-456-4389
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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 | 30874
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License Number State | CA
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