MEDICARE: DR. MITRA RAZIPOUR DC

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	DC29373	CA

General Provider Information

NPI Number	:	1235234048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITRA RAZIPOUR DC

Provider Business Mailing Address
First Line	:	20969 VENTURA BLVD
Second Line	:	SUITE 23
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-2305
Country	:	US
Telephone Number	:	818-992-5252
Fax Number	:	818-992-5292

Provider Business Practice Location Address
First Line	:	20969 VENTURA BLVD
Second Line	:	SUITE 23
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-2305
Country	:	US
Telephone Number	:	818-992-5252
Fax Number	:	818-992-5292

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/13/2012

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