Provider Demographics
NPI:1588846372
Name:OMID OKHOWAT CHIROPRACTIC INC
Entity Type:Organization
Organization Name:OMID OKHOWAT CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OMID
Authorized Official - Middle Name:
Authorized Official - Last Name:OKHOWAT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:323-933-3357
Mailing Address - Street 1:6221 WILSHIRE BLVD STE 326
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5224
Mailing Address - Country:US
Mailing Address - Phone:323-933-3357
Mailing Address - Fax:323-933-1116
Practice Address - Street 1:6221 WILSHIRE BLVD STE 326
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5225
Practice Address - Country:US
Practice Address - Phone:323-933-3357
Practice Address - Fax:323-933-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26462111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty