Provider Demographics
NPI:1316411846
Name:MANANIAN CHIROPRACTIC, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MANANIAN CHIROPRACTIC, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARIK
Authorized Official - Middle Name:
Authorized Official - Last Name:MANANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-333-6952
Mailing Address - Street 1:2032 THOMPSON CT STE 9
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1652
Mailing Address - Country:US
Mailing Address - Phone:818-333-6952
Mailing Address - Fax:
Practice Address - Street 1:2032 THOMPSON CT STE 9
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1652
Practice Address - Country:US
Practice Address - Phone:818-333-6952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-17
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1003313883Medicaid