Provider Demographics
NPI:1639646078
Name:ELYASI CHIROPRACTIC, APC
Entity Type:Organization
Organization Name:ELYASI CHIROPRACTIC, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:POURIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELYASI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-628-0727
Mailing Address - Street 1:428 N PALM DR APT 104
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-3937
Mailing Address - Country:US
Mailing Address - Phone:310-628-0727
Mailing Address - Fax:
Practice Address - Street 1:505 S PACIFIC AVE STE 103
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-2656
Practice Address - Country:US
Practice Address - Phone:310-628-0727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty