Provider Demographics
NPI:1619018850
Name:SHAHRESTANI, BABAK ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:BABAK
Middle Name:ROBERT
Last Name:SHAHRESTANI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2328 NEWPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-1548
Mailing Address - Country:US
Mailing Address - Phone:949-631-3139
Mailing Address - Fax:949-631-0747
Practice Address - Street 1:2328 NEWPORT BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-1548
Practice Address - Country:US
Practice Address - Phone:949-631-3139
Practice Address - Fax:949-631-0747
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19600111N00000X
CADC19600111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33-0479857OtherOLD CORPORATE NUMBER
CA33-0793733OtherCORPORATE NUMBER
CA33-0793733OtherCORPORATE NUMBER