Provider Demographics
NPI:1265838569
Name:DESAI CHIROPRACTIC PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DESAI CHIROPRACTIC PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSHANI
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-733-6194
Mailing Address - Street 1:700 N PACIFIC COAST HWY
Mailing Address - Street 2:STE. 302
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2167
Mailing Address - Country:US
Mailing Address - Phone:310-734-2040
Mailing Address - Fax:310-598-2040
Practice Address - Street 1:700 N PACIFIC COAST HWY
Practice Address - Street 2:STE. 302
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2167
Practice Address - Country:US
Practice Address - Phone:310-734-2040
Practice Address - Fax:310-598-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32410111N00000X, 111N00000X
CA33011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty