Provider Demographics
NPI:1306001979
Name:KHOSROVIAN, RODRIK (DC)
Entity Type:Individual
Prefix:DR
First Name:RODRIK
Middle Name:
Last Name:KHOSROVIAN
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 1:610 N CENTRAL AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1403
Mailing Address - Country:US
Mailing Address - Phone:818-240-0288
Mailing Address - Fax:818-240-0711
Practice Address - Street 1:610 N CENTRAL AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1403
Practice Address - Country:US
Practice Address - Phone:818-240-0288
Practice Address - Fax:818-240-0711
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-27618111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor