Provider Demographics
NPI:1114324936
Name:MIRSHOJAE CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:MIRSHOJAE CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRSHOJAE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-757-7246
Mailing Address - Street 1:18318 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4424
Mailing Address - Country:US
Mailing Address - Phone:818-757-7246
Mailing Address - Fax:818-757-3024
Practice Address - Street 1:18318 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4424
Practice Address - Country:US
Practice Address - Phone:818-757-7246
Practice Address - Fax:818-757-3024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22086261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy