Provider Demographics
NPI:1437291523
Name:SIMON NAZARIAN CHIROPRACTIC CORP.
Entity Type:Organization
Organization Name:SIMON NAZARIAN CHIROPRACTIC CORP.
Other - Org Name:UNIVERSAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, DC
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-988-7722
Mailing Address - Street 1:14540 VICTORY BLVD
Mailing Address - Street 2:SUITE# 101
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1600
Mailing Address - Country:US
Mailing Address - Phone:818-989-8772
Mailing Address - Fax:818-988-7733
Practice Address - Street 1:14540 VICTORY BLVD
Practice Address - Street 2:SUITE# 101
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1600
Practice Address - Country:US
Practice Address - Phone:818-989-8772
Practice Address - Fax:818-988-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23076111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty