=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306594379
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FATHI WELLNESS AND CHIROPRACTIC CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2022
-----------------------------------------------------
Last Update Date | 03/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23601 MOULTON PKWY STE E
-----------------------------------------------------
City | LAGUNA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92653-1979
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-888-5400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23601 MOULTON PKWY STE E
-----------------------------------------------------
City | LAGUNA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92653-1979
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-888-5400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ARMAN FATHI
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 312-888-5400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------