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General NPI Number Information
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NPI Number | 1356404065
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Entity Type | Individual
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Provider Name | KEYVAN EGHBALI D.C.
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Gender | Male
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 01/30/2008
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Provider Practice Location Address
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Address Line | 19100 VENTURA BLVD STE Q
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City | TARZANA
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State | CA
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Zip | 91356-3238
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Country | US
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Telephone | 818-789-4325
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Fax | 818-668-2050
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Provider Business Mailing Address
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Address Line | 19100 VENTURA BLVD #Q
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City | TARZANA
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State | CA
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Zip | 91356-3238
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Country | US
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Telephone | 818-789-4325
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Fax | 818-668-2050
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DC24802
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License Number State | CA
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