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General NPI Number Information
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NPI Number | 1265838569
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Entity Type | Organization
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Legal Business Name | DESAI CHIROPRACTIC PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/13/2014
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Last Update Date | 05/21/2015
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Provider Practice Location Address
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Address Line | 700 N PACIFIC COAST HWY STE. 302
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City | REDONDO BEACH
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State | CA
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Zip | 90277-2167
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Country | US
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Telephone | 310-734-2040
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Fax | 310-598-2040
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Provider Business Mailing Address
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Address Line | 700 N PACIFIC COAST HWY STE. 302
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City | REDONDO BEACH
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State | CA
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Zip | 90277-2167
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Country | US
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Telephone | 310-734-2040
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Fax | 310-598-2040
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROSHANI DESAI
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Credential | D.C.
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Telephone | 951-733-6194
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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 | 33011
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 32410
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License Number State | CA
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