MEDICARE: NAZARIAN FAMILY CHIROPRACTIC A PROFESSIONAL CORPORATION

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	DC23926	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W21238	OTHER	CA	GROUP PTAN
2	DC0239260	OTHER	CA	BLUE SHIELD
3	1952344855	OTHER	CA	INDIVIDUAL NPI
4	WDC23926A	OTHER	CA	INDIVIDUAL PTAN

General Provider Information

NPI Number	:	1639116981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAZARIAN FAMILY CHIROPRACTIC A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	15550 ROCKFIELD BLVD
Second Line	:	B220
City	:	IRVINE
State	:	CA
Zip	:	92618-2720
Country	:	US
Telephone Number	:	949-598-9999
Fax Number	:	949-598-9990

Provider Business Practice Location Address
First Line	:	10921 WILSHIRE BLVD
Second Line	:	SUITE# 801
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-3906
Country	:	US
Telephone Number	:	310-209-0425
Fax Number	:	310-209-0495

Authorized Official
Title or Position	:	PROVIDER/OWNER
Name	:	MR. VICTOR M NAZARIAN
Credential	:	D.C.
Telephone Number	:	310-209-0425

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	10/13/2010

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