Provider Demographics
NPI:1154495646
Name:JAVAHERIAN, NICOLE NILOOFAR (DC)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:NILOOFAR
Last Name:JAVAHERIAN
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 1:16101 VENTURA BLVD
Mailing Address - Street 2:SUITE 328
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436
Mailing Address - Country:US
Mailing Address - Phone:818-995-4481
Mailing Address - Fax:818-907-8648
Practice Address - Street 1:16101 VENTURA BLVD
Practice Address - Street 2:SUITE 328
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436
Practice Address - Country:US
Practice Address - Phone:818-995-4481
Practice Address - Fax:818-907-8648
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA24258Medicare ID - Type Unspecified