MEDICARE: NIKOO JAVANMARDI DC LLC

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

General Provider Information

NPI Number	:	1699494096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIKOO JAVANMARDI DC LLC

Provider Business Mailing Address
First Line	:	417 GRAND AVE STE 101
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-3639
Country	:	US
Telephone Number	:	650-871-1364
Fax Number	:

Provider Business Practice Location Address
First Line	:	417 GRAND AVE STE 101
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-3639
Country	:	US
Telephone Number	:	650-871-1364
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	NIKOO JAVANMARDI
Credential	:	DC
Telephone Number	:	650-871-1364

Provider Enumeration Date	:	08/26/2022
Last Update Date	:	08/26/2022

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