Provider Demographics
NPI:1467722231
Name:DERAKHSHAN, SETAREH (DC)
Entity Type:Individual
Prefix:DR
First Name:SETAREH
Middle Name:
Last Name:DERAKHSHAN
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 1:1533 SHATTUCK AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-1516
Mailing Address - Country:US
Mailing Address - Phone:678-993-3196
Mailing Address - Fax:510-666-0312
Practice Address - Street 1:221E WALNUT ST 275
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-6001
Practice Address - Country:US
Practice Address - Phone:626-765-0555
Practice Address - Fax:626-765-0248
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor