Provider Demographics
NPI:1497194542
Name:KHODABAKHSH CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:KHODABAKHSH CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHODABAKHSH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:925-786-1340
Mailing Address - Street 1:15550 ROCKFIELD BLVD
Mailing Address - Street 2:B220
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2720
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:811 SAN RAMON VALLEY BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4025
Practice Address - Country:US
Practice Address - Phone:925-786-1340
Practice Address - Fax:925-208-1734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty