Provider Demographics
NPI:1053678912
Name:YANIV JAY DVORA CHIROPRACTIC CORP
Entity Type:Organization
Organization Name:YANIV JAY DVORA CHIROPRACTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YANIV
Authorized Official - Middle Name:J
Authorized Official - Last Name:DVORA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-584-1114
Mailing Address - Street 1:2072 TAPO ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-3441
Mailing Address - Country:US
Mailing Address - Phone:805-584-1114
Mailing Address - Fax:805-584-3102
Practice Address - Street 1:2072 TAPO ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-3441
Practice Address - Country:US
Practice Address - Phone:805-584-1114
Practice Address - Fax:805-584-3102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27909111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV05913Medicare UPIN