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General NPI Number Information
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NPI Number | 1245372408
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Entity Type | Organization
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Legal Business Name | SOHEIL MEHDIZADEH CHIROPRACTIC CORP.
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 05/05/2014
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Provider Practice Location Address
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Address Line | 2105 BEVERLY BLVD SUITE# 207
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City | LOS ANGELES
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State | CA
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Zip | 90057-2216
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Country | US
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Telephone | 310-704-4757
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Fax | 310-734-7567
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Provider Business Mailing Address
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Address Line | 2105 BEVERLY BLVD SUITE# 207
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City | LOS ANGELES
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State | CA
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Zip | 90057-2216
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Country | US
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Telephone | 310-704-4757
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Fax | 310-734-7567
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Authorized Official
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Title or Position | PRESIDENT, DOCTOR OF CHIROPRACTIC
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Name | DR. SOHEIL MEHDIZADEH
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Credential | D.C., IDE, Q.M.E.
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Telephone | 310-704-4757
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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 | DC 25086
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License Number State | CA
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