Provider Demographics
NPI:1043398589
Name:KHODABAKHSHIAN, SEVAK E (DC)
Entity Type:Individual
Prefix:DR
First Name:SEVAK
Middle Name:E
Last Name:KHODABAKHSHIAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 ROLLING OAKS DR STE 250
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1087
Mailing Address - Country:US
Mailing Address - Phone:805-230-2673
Mailing Address - Fax:805-230-2134
Practice Address - Street 1:325 ROLLING OAKS DR STE 250
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1087
Practice Address - Country:US
Practice Address - Phone:805-230-2673
Practice Address - Fax:805-230-2134
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22785111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation