Provider Demographics
NPI:1497046973
Name:SAMAAN, ELIE (DC, MUAC)
Entity Type:Individual
Prefix:DR
First Name:ELIE
Middle Name:
Last Name:SAMAAN
Suffix:
Gender:M
Credentials:DC, MUAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 N JACKSON ST APT 8
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-3275
Mailing Address - Country:US
Mailing Address - Phone:818-438-5387
Mailing Address - Fax:
Practice Address - Street 1:1613 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-4521
Practice Address - Country:US
Practice Address - Phone:323-731-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28531111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor