Provider Demographics
NPI:1376006767
Name:VARTANYAN, VARTAN (DC)
Entity Type:Individual
Prefix:DR
First Name:VARTAN
Middle Name:
Last Name:VARTANYAN
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 1:17835 VENTURA BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3672
Mailing Address - Country:US
Mailing Address - Phone:805-552-6865
Mailing Address - Fax:310-347-4543
Practice Address - Street 1:17835 VENTURA BLVD STE 207
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3672
Practice Address - Country:US
Practice Address - Phone:805-552-6865
Practice Address - Fax:310-347-4543
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty