MEDICARE: ATOUSA MAHDAVI CHIROPRACTOR

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	111NS0005X	Sports Physician Chiropractor	DC23453	CA

General Provider Information

NPI Number	:	1932386687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATOUSA MAHDAVI CHIROPRACTOR

Provider Business Mailing Address
First Line	:	292 S LA CIENEGA BLVD
Second Line	:	SUITE 101
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3330
Country	:	US
Telephone Number	:	310-289-9770
Fax Number	:

Provider Business Practice Location Address
First Line	:	292 S LA CIENEGA BLVD
Second Line	:	SUITE 101
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3330
Country	:	US
Telephone Number	:	310-289-9770
Fax Number	:

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

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	01/24/2008

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