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General NPI Number Information
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NPI Number | 1508100173
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Entity Type | Organization
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Legal Business Name | SHIVA NAZEMI CHIROPRACTIC CORPORATION, INC.
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Dates
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Enumeration Date | 11/20/2012
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 15206 VENTURA BLVD. SUITE 203
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-3392
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Country | US
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Telephone | 818-808-0047
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Fax | 818-808-0047
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Provider Business Mailing Address
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Address Line | 15206 VENTURA BLVD. SUITE 203
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-3392
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Country | US
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Telephone | 818-808-0047
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Fax | 818-808-0047
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHIVA NAZEMI
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Credential | D.C.
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Telephone | 818-808-0047
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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 | DC25603
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License Number State | CA
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