Provider Demographics
NPI:1043631088
Name:KAIVAN-MEHR CHIROPRACTIC INC
Entity Type:Organization
Organization Name:KAIVAN-MEHR CHIROPRACTIC INC
Other - Org Name:FOOTHILL FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AFSHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAIVAN-MEHR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:626-253-7139
Mailing Address - Street 1:2138 BONITA AVE
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-4915
Mailing Address - Country:US
Mailing Address - Phone:909-596-1038
Mailing Address - Fax:909-596-6059
Practice Address - Street 1:2138 BONITA AVE
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-4915
Practice Address - Country:US
Practice Address - Phone:909-596-1038
Practice Address - Fax:909-596-6059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherEIN