Provider Demographics
NPI:1457673840
Name:BALAKHANI S CHIROPRACTIC PROFESSIONAL INC
Entity Type:Organization
Organization Name:BALAKHANI S CHIROPRACTIC PROFESSIONAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BALAKHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-888-8802
Mailing Address - Street 1:11645 WILSHIRE BLVD
Mailing Address - Street 2:# 745
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1708
Mailing Address - Country:US
Mailing Address - Phone:310-488-8880
Mailing Address - Fax:310-696-0700
Practice Address - Street 1:11645 WILSHIRE BLVD
Practice Address - Street 2:# 745
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6800
Practice Address - Country:US
Practice Address - Phone:310-888-8802
Practice Address - Fax:310-696-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty