Provider Demographics
NPI:1154654291
Name:BARDEKJIAN, SANAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SANAN
Middle Name:
Last Name:BARDEKJIAN
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 1:321 N MACLAY AVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-2970
Mailing Address - Country:US
Mailing Address - Phone:818-898-1000
Mailing Address - Fax:818-898-1010
Practice Address - Street 1:321 N MACLAY AVE
Practice Address - Street 2:UNIT C
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-2970
Practice Address - Country:US
Practice Address - Phone:818-898-1000
Practice Address - Fax:818-898-1010
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31195111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor