MEDICARE: DR. FARZANEH DERAKHSHANFAR D.C.

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	CA25005	CA

General Provider Information

NPI Number	:	1750564035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FARZANEH DERAKHSHANFAR D.C.

Provider Business Mailing Address
First Line	:	PO BOX 570696
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91357-0696
Country	:	US
Telephone Number	:	818-731-2627
Fax Number	:	323-852-1722

Provider Business Practice Location Address
First Line	:	6399 WILSHIRE BLVD STE 315
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5706
Country	:	US
Telephone Number	:	323-236-8467
Fax Number	:	323-852-1722

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

Provider Enumeration Date	:	12/10/2007
Last Update Date	:	12/10/2007

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