Provider Demographics
NPI:1225120587
Name:PAVEL GRYUNSHPAN CHIROPRACTIC INC
Entity Type:Organization
Organization Name:PAVEL GRYUNSHPAN CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRYUNSHPAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:323-936-0149
Mailing Address - Street 1:425 S FAIRFAX AVE # 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3148
Mailing Address - Country:US
Mailing Address - Phone:323-936-0149
Mailing Address - Fax:323-936-0173
Practice Address - Street 1:425 S FAIRFAX AVE # 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3148
Practice Address - Country:US
Practice Address - Phone:323-936-0149
Practice Address - Fax:323-936-0173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29542111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty