Provider Demographics
NPI:1457686859
Name:ADVANCED CHIROPRACTIC GROUP
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:HOMAYOUN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HAMIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-863-6196
Mailing Address - Street 1:18308 SHERMAN WAY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4432
Mailing Address - Country:US
Mailing Address - Phone:818-345-4388
Mailing Address - Fax:818-345-4387
Practice Address - Street 1:18308 SHERMAN WAY
Practice Address - Street 2:SUITE 4
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4432
Practice Address - Country:US
Practice Address - Phone:818-345-4388
Practice Address - Fax:818-345-4387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty