Provider Demographics
NPI:1568492205
Name:F FRED VAZIRI DC A PROFESSIONAL CHIROPRACTIC CORP
Entity Type:Organization
Organization Name:F FRED VAZIRI DC A PROFESSIONAL CHIROPRACTIC CORP
Other - Org Name:VAZIRI ALTERNATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZIRI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-704-1188
Mailing Address - Street 1:20929 VENTURA BLVD
Mailing Address - Street 2:STE 25
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364
Mailing Address - Country:US
Mailing Address - Phone:818-704-1188
Mailing Address - Fax:818-704-9588
Practice Address - Street 1:20929 VENTURA BLVD
Practice Address - Street 2:STE 25
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364
Practice Address - Country:US
Practice Address - Phone:818-704-1188
Practice Address - Fax:818-704-9588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21157111N00000X
CAAC9345171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW22263Medicare PIN