MEDICARE: ARA MICHAEL KEKLIKIAN 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	DC25205	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC25205	OTHER	CA	CA BOARD

General Provider Information

NPI Number	:	1922481076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARA MICHAEL KEKLIKIAN D.C.

Provider Business Mailing Address
First Line	:	425 W BROADWAY STE 440
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-1366
Country	:	US
Telephone Number	:	818-247-7566
Fax Number	:	818-254-0003

Provider Business Practice Location Address
First Line	:	425 W BROADWAY STE 440
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-1366
Country	:	US
Telephone Number	:	818-247-7566
Fax Number	:

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

Provider Enumeration Date	:	07/08/2015
Last Update Date	:	01/29/2019

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