Provider Demographics
NPI:1114331907
Name:SHAHEENIAN, SOSEEG (DC)
Entity Type:Individual
Prefix:
First Name:SOSEEG
Middle Name:
Last Name:SHAHEENIAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N MACLAY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-1326
Mailing Address - Country:US
Mailing Address - Phone:818-365-8509
Mailing Address - Fax:
Practice Address - Street 1:1000 N MACLAY AVE
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-1326
Practice Address - Country:US
Practice Address - Phone:818-564-0158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2023-03-28
Deactivation Date:2022-09-12
Deactivation Code:
Reactivation Date:2022-10-05
Provider Licenses
StateLicense IDTaxonomies
CADC21123111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor