Provider Demographics
NPI:1447383138
Name:BAHADORI, ATOUSA (DC)
Entity Type:Individual
Prefix:
First Name:ATOUSA
Middle Name:
Last Name:BAHADORI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 NATIONAL BLVD STE 340
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-4142
Mailing Address - Country:US
Mailing Address - Phone:310-288-9884
Mailing Address - Fax:310-388-5388
Practice Address - Street 1:10801 NATIONAL BLVD
Practice Address - Street 2:SUITE # 340
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-4139
Practice Address - Country:US
Practice Address - Phone:310-288-9884
Practice Address - Fax:310-388-5388
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26603111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor