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General NPI Number Information
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NPI Number | 1457673840
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Entity Type | Organization
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Legal Business Name | BALAKHANI S CHIROPRACTIC PROFESSIONAL INC
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Dates
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Enumeration Date | 02/25/2010
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Last Update Date | 07/11/2012
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Provider Practice Location Address
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Address Line | 11645 WILSHIRE BLVD # 745
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City | LOS ANGELES
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State | CA
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Zip | 90025-6800
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Country | US
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Telephone | 310-888-8802
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Fax | 310-696-0700
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Provider Business Mailing Address
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Address Line | 11645 WILSHIRE BLVD # 745
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City | LOS ANGELES
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State | CA
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Zip | 90025-1708
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Country | US
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Telephone | 310-488-8880
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Fax | 310-696-0700
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHAHRAM BALAKHANI
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Credential | D.C
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Telephone | 310-888-8802
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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 | DC26604
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License Number State | CA
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