Provider Demographics
NPI:1063681252
Name:GALAJIAN CHIROPRACTIC PR
Entity Type:Organization
Organization Name:GALAJIAN CHIROPRACTIC PR
Other - Org Name:VERDUGO CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GALAJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:323-661-9291
Mailing Address - Street 1:5123 W SUNSET BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5779
Mailing Address - Country:US
Mailing Address - Phone:323-661-9291
Mailing Address - Fax:323-661-8646
Practice Address - Street 1:239 S VERDUGO RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1458
Practice Address - Country:US
Practice Address - Phone:818-543-7605
Practice Address - Fax:818-291-8435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15806AMedicare PIN