Provider Demographics
NPI:1003920067
Name:CHINCHILLA, PAV (DC)
Entity Type:Individual
Prefix:
First Name:PAV
Middle Name:
Last Name:CHINCHILLA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:PAV
Other - Middle Name:KHIET
Other - Last Name:SOUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:6456 YORK BLVD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90042-3642
Mailing Address - Country:US
Mailing Address - Phone:800-775-7787
Mailing Address - Fax:
Practice Address - Street 1:6456 YORK BLVD
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:CA
Practice Address - Zip Code:90042-3642
Practice Address - Country:US
Practice Address - Phone:800-775-7787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor