Provider Demographics
NPI:1225428311
Name:DERAKHSHAN CHIROPRACTIC
Entity Type:Organization
Organization Name:DERAKHSHAN CHIROPRACTIC
Other - Org Name:YOUR HEALTH IN MOTION
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SETAREH
Authorized Official - Middle Name:
Authorized Official - Last Name:DERAKHSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:626-765-0555
Mailing Address - Street 1:221 E WALNUT ST
Mailing Address - Street 2:SUITE275
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1585
Mailing Address - Country:US
Mailing Address - Phone:626-765-0555
Mailing Address - Fax:626-765-0248
Practice Address - Street 1:221 E WALNUT ST
Practice Address - Street 2:SUITE275
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1585
Practice Address - Country:US
Practice Address - Phone:626-765-0555
Practice Address - Fax:626-765-0248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty