Provider Demographics
NPI:1629080536
Name:FARIMA YEGANEGI CHIROPRACTIC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:FARIMA YEGANEGI CHIROPRACTIC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FARIMA
Authorized Official - Middle Name:N
Authorized Official - Last Name:YEGANEGI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-377-4700
Mailing Address - Street 1:1954 CAMDEN AVE
Mailing Address - Street 2:SUITE# 6
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-2844
Mailing Address - Country:US
Mailing Address - Phone:408-377-4700
Mailing Address - Fax:408-377-4703
Practice Address - Street 1:1954 CAMDEN AVE
Practice Address - Street 2:SUITE# 6
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-2844
Practice Address - Country:US
Practice Address - Phone:408-377-4700
Practice Address - Fax:408-377-4703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA019338111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0193380Medicare ID - Type Unspecified