=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942734967
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESTORATION HEALTH CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2017
-----------------------------------------------------
Last Update Date | 04/17/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7011 N HOWARD ST SUITE 101
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93720-2955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-261-2700
-----------------------------------------------------
Fax | 559-261-0333
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2021 22ND ST
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93301-3802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-447-4200
-----------------------------------------------------
Fax | 661-447-4100
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | DR. REZA SHAKERI
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 559-977-8910
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC0259290
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------