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General NPI Number Information
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NPI Number | 1164825659
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Entity Type | Organization
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Legal Business Name | SORAYA CHIROPRACTIC CARE INC
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Dates
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Enumeration Date | 09/29/2014
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Last Update Date | 09/29/2014
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Provider Practice Location Address
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Address Line | 2121 AVENUE OF THE STARS
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City | LOS ANGELES
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State | CA
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Zip | 90067-5010
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Country | US
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Telephone | 310-467-5218
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Fax | 310-933-0559
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Provider Business Mailing Address
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Address Line | 959 S MULLEN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90019-1829
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Country | US
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Telephone | 310-467-5218
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Fax | 310-933-0559
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Authorized Official
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Title or Position | OWNER
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Name | DAMON SORAYA
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Credential | D C
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Telephone | 310-467-5218
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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 | DC30645
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License Number State | CA
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