Provider Demographics
NPI:1447390661
Name:AZITA TABASSIAN CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:AZITA TABASSIAN CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AZITA
Authorized Official - Middle Name:
Authorized Official - Last Name:TABASSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-615-1884
Mailing Address - Street 1:30055 AVENIDA ESPLENDIDA
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-5420
Mailing Address - Country:US
Mailing Address - Phone:310-615-1884
Mailing Address - Fax:817-549-5159
Practice Address - Street 1:1200 ROSECRANS AVE
Practice Address - Street 2:SUITE#211
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2462
Practice Address - Country:US
Practice Address - Phone:310-615-1884
Practice Address - Fax:817-549-5159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZZZ64463Z111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ64463ZOtherBLUESHIELD OF CALIFORNIA
CAZZZ64463ZOtherBLUESHIELD OF CALIFORNIA
CAU74349Medicare UPIN