Provider Demographics
NPI:1013555051
Name:ELYASI DEL TORTO CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:ELYASI DEL TORTO CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:POURIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELYASI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-935-2182
Mailing Address - Street 1:505 S PACIFIC AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-2656
Mailing Address - Country:US
Mailing Address - Phone:310-935-2182
Mailing Address - Fax:
Practice Address - Street 1:505 S PACIFIC AVE STE 103
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-2656
Practice Address - Country:US
Practice Address - Phone:310-935-2182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty