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General NPI Number Information
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NPI Number | 1639646078
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Entity Type | Organization
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Legal Business Name | ELYASI CHIROPRACTIC, APC
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Dates
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Enumeration Date | 10/24/2018
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Last Update Date | 10/24/2018
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Provider Practice Location Address
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Address Line | 505 S PACIFIC AVE STE 103
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City | SAN PEDRO
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State | CA
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Zip | 90731-2656
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Country | US
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Telephone | 310-628-0727
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Fax |
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Provider Business Mailing Address
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Address Line | 428 N PALM DR APT 104
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-3937
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Country | US
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Telephone | 310-628-0727
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Fax |
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. POURIYA ELYASI
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Credential |
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Telephone | 310-628-0727
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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 |
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License Number State |
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