Provider Demographics
NPI:1578597605
Name:VAZIRI, FRED (DC, LAC, QME)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:
Last Name:VAZIRI
Suffix:
Gender:M
Credentials:DC, LAC, QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20929 VENTURA BLVD 25
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-3353
Mailing Address - Country:US
Mailing Address - Phone:818-704-1188
Mailing Address - Fax:818-704-9588
Practice Address - Street 1:20929 VENTURA BLVD 25
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-3353
Practice Address - Country:US
Practice Address - Phone:818-704-1188
Practice Address - Fax:818-704-9588
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21157111N00000X
CAAC9345171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC21157AMedicare ID - Type UnspecifiedCHIROPRACTIC