Provider Demographics
NPI:1376520775
Name:BAGHERIAN, ALIREZA (DC)
Entity Type:Individual
Prefix:DR
First Name:ALIREZA
Middle Name:
Last Name:BAGHERIAN
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 1:3580 CALIFORNIA ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1725
Mailing Address - Country:US
Mailing Address - Phone:415-921-6200
Mailing Address - Fax:415-921-6209
Practice Address - Street 1:3580 CALIFORNIA ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1725
Practice Address - Country:US
Practice Address - Phone:415-921-6200
Practice Address - Fax:415-921-6209
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25120111N00000X
CA25120111NS0005X, 111NX0100X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Not Answered111NX0100XChiropractic ProvidersChiropractorOccupational Health
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC25120OtherCHIROPRACTIC ID
CAZZZ31125ZMedicare ID - Type UnspecifiedMEDICARE ID