Provider Demographics
NPI:1346275161
Name:BOULDOUKIAN, GARO H (DC)
Entity Type:Individual
Prefix:MR
First Name:GARO
Middle Name:H
Last Name:BOULDOUKIAN
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 1:3200 LA CRESCENTA AVE #A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208
Mailing Address - Country:US
Mailing Address - Phone:818-236-2708
Mailing Address - Fax:818-236-2738
Practice Address - Street 1:3200 LA CRESCENTA AVE #A
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208
Practice Address - Country:US
Practice Address - Phone:818-236-2708
Practice Address - Fax:818-236-2738
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16274111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor