MEDICARE: DEVAKHSHESH CHIROPRACTIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	25524273	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC24112	OTHER	CA	CHIROPRACTOR

General Provider Information

NPI Number	:	1093897746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVAKHSHESH CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	1016 S ROBERTSON BLVD # 1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1505
Country	:	US
Telephone Number	:	310-652-9283
Fax Number	:

Provider Business Practice Location Address
First Line	:	1016 S ROBERTSON BLVD # 1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1505
Country	:	US
Telephone Number	:	310-652-9283
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR (PRESIDENT)
Name	:	ALFRED A DERAKHSHESH
Credential	:
Telephone Number	:	310-652-9293

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	08/11/2008

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