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General NPI Number Information
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NPI Number | 1235621855
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Entity Type | Organization
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Legal Business Name | ARYAN DIBAGOHAR DC A PROFESSIONAL CHIROPRACTIC CORPORATION
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 06/05/2018
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Provider Practice Location Address
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Address Line | 16430 VENTURA BLVD STE 106
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City | ENCINO
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State | CA
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Zip | 91436
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Country | US
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Telephone | 818-646-6167
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Fax |
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Provider Business Mailing Address
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Address Line | 17361 GILMORE ST
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City | VAN NUYS
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State | CA
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Zip | 91406-5417
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Country | US
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Telephone | 818-974-9323
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ARYAN DIBAGOHAR
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Credential | DC
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Telephone | 818-974-9323
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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 | 34067
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License Number State | CA
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