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General NPI Number Information
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NPI Number | 1497194542
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Entity Type | Organization
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Legal Business Name | KHODABAKHSH CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 06/21/2013
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 801 SAN RAMON VALLEY BLVD STE G
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City | DANVILLE
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State | CA
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Zip | 94526-4027
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Country | US
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Telephone | 925-718-5314
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Fax | 925-208-1734
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Provider Business Mailing Address
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Address Line | 801 SAN RAMON VALLEY BLVD STE G
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City | DANVILLE
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State | CA
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Zip | 94526-4027
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Country | US
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Telephone | 925-718-5314
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Fax | 949-598-9990
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. MAHSA KHODABAKHSH
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Credential | D.C.
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Telephone | 925-786-1340
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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 | DC32028
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License Number State | CA
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