Provider Demographics
NPI:1124549605
Name:MINAEIAN, TENI (DC)
Entity Type:Individual
Prefix:
First Name:TENI
Middle Name:
Last Name:MINAEIAN
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:PO BOX 2032
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91209-2032
Mailing Address - Country:US
Mailing Address - Phone:818-265-2245
Mailing Address - Fax:877-575-9782
Practice Address - Street 1:1451 E CHEVY CHASE DR STE 201
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4056
Practice Address - Country:US
Practice Address - Phone:818-265-2245
Practice Address - Fax:877-575-9782
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32994111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition