Provider Demographics
NPI:1467585711
Name:JALALI, FARAHNAZ (DC, QME)
Entity Type:Individual
Prefix:DR
First Name:FARAHNAZ
Middle Name:
Last Name:JALALI
Suffix:
Gender:F
Credentials:DC, QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19231 VICTORY BLVD
Mailing Address - Street 2:SUITE 556
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6308
Mailing Address - Country:US
Mailing Address - Phone:818-668-8136
Mailing Address - Fax:818-344-4349
Practice Address - Street 1:19231 VICTORY BLVD
Practice Address - Street 2:SUITE 556
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6308
Practice Address - Country:US
Practice Address - Phone:818-668-8136
Practice Address - Fax:818-344-4349
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U70654Medicare UPIN
CADC0230230Medicare ID - Type Unspecified