Provider Demographics
NPI:1093014078
Name:NAZAR, JEMISS (DC)
Entity Type:Individual
Prefix:
First Name:JEMISS
Middle Name:
Last Name:NAZAR
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 1:12444 VICTORY BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3184
Mailing Address - Country:US
Mailing Address - Phone:818-761-4242
Mailing Address - Fax:818-760-6441
Practice Address - Street 1:12444 VICTORY BLVD STE 106
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3184
Practice Address - Country:US
Practice Address - Phone:818-761-4242
Practice Address - Fax:818-760-6441
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23480111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner