MEDICARE: MITRA RAZIPOUR CHIROPRACTIC PROFESSIONAL CORP

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	DC29373	CA

General Provider Information

NPI Number	:	1992839385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MITRA RAZIPOUR CHIROPRACTIC PROFESSIONAL CORP

Provider Business Mailing Address
First Line	:	20969 VENTURA BLVD
Second Line	:	STE 23
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-2305
Country	:	US
Telephone Number	:	818-992-5252
Fax Number	:	818-992-5292

Provider Business Practice Location Address
First Line	:	20969 VENTURA BLVD
Second Line	:	STE 23
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-2305
Country	:	US
Telephone Number	:	818-992-5252
Fax Number	:	818-992-5292

Authorized Official
Title or Position	:	CEO
Name	:	MITRA RAZIPOUR
Credential	:	D.C.
Telephone Number	:	818-992-5252

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	08/22/2020

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