Provider Demographics
NPI:1619162716
Name:RAD, SHAHRIAR S (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAHRIAR
Middle Name:S
Last Name:RAD
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 1:8349 RESEDA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4622
Mailing Address - Country:US
Mailing Address - Phone:818-701-9868
Mailing Address - Fax:818-701-9898
Practice Address - Street 1:8349 RESEDA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4622
Practice Address - Country:US
Practice Address - Phone:818-701-9868
Practice Address - Fax:818-701-9898
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21478111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor