Provider Demographics
NPI:1093444820
Name:CLISBY-TITIZIAN CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:CLISBY-TITIZIAN CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GASSIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TITIZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-244-7600
Mailing Address - Street 1:1620 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-2915
Mailing Address - Country:US
Mailing Address - Phone:818-244-7600
Mailing Address - Fax:818-244-6400
Practice Address - Street 1:615 W 9TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3107
Practice Address - Country:US
Practice Address - Phone:818-244-7600
Practice Address - Fax:818-244-6400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC30877OtherLICENSE