MEDICARE: KHODABAKHSH 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	DC32028	CA

General Provider Information

NPI Number	:	1497194542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KHODABAKHSH CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	801 SAN RAMON VALLEY BLVD STE G
Second Line	:
City	:	DANVILLE
State	:	CA
Zip	:	94526-4027
Country	:	US
Telephone Number	:	925-718-5314
Fax Number	:	949-598-9990

Provider Business Practice Location Address
First Line	:	801 SAN RAMON VALLEY BLVD STE G
Second Line	:
City	:	DANVILLE
State	:	CA
Zip	:	94526-4027
Country	:	US
Telephone Number	:	925-718-5314
Fax Number	:	925-208-1734

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. MAHSA KHODABAKHSH
Credential	:	D.C.
Telephone Number	:	925-786-1340

Provider Enumeration Date	:	06/21/2013
Last Update Date	:	11/08/2024

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