MEDICARE: BAHAR DANESH-GHARIB 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	DC28361	CA

General Provider Information

NPI Number	:	1497888911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAHAR DANESH-GHARIB CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	132 S VERMONT AVE
Second Line	:	SUITE #204
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-5954
Country	:	US
Telephone Number	:	213-389-2526
Fax Number	:	213-389-2506

Provider Business Practice Location Address
First Line	:	17547 VENTURA BLVD
Second Line	:	SUITE # 308-A
City	:	ENCINO
State	:	CA
Zip	:	91316-3853
Country	:	US
Telephone Number	:	818-906-8972
Fax Number	:	818-906-8947

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BAHAR DANESH GHARIB
Credential	:	D.C.
Telephone Number	:	213-389-2526

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	08/22/2020

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