Provider Demographics
NPI:1396199899
Name:SOCAL CHIROPRACTIC
Entity Type:Organization
Organization Name:SOCAL CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:NAWEED
Authorized Official - Last Name:KAZEM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-363-2373
Mailing Address - Street 1:2535 OLD QUARRY RD
Mailing Address - Street 2:#1104
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-2750
Mailing Address - Country:US
Mailing Address - Phone:619-363-2373
Mailing Address - Fax:
Practice Address - Street 1:4080 CENTRE ST STE 202
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2657
Practice Address - Country:US
Practice Address - Phone:619-363-2373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty