Provider Demographics
NPI:1275049785
Name:DIBAGOHAR, ARYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:ARYAN
Middle Name:
Last Name:DIBAGOHAR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16430 VENTURA BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2135
Mailing Address - Country:US
Mailing Address - Phone:818-646-6167
Mailing Address - Fax:818-646-6167
Practice Address - Street 1:16430 VENTURA BLVD STE 106
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2135
Practice Address - Country:US
Practice Address - Phone:818-646-6167
Practice Address - Fax:818-646-6167
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34067111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor