Provider Demographics
NPI:1649422320
Name:GHARIBIAN, HERATCH (DC)
Entity Type:Individual
Prefix:
First Name:HERATCH
Middle Name:
Last Name:GHARIBIAN
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 1:3436 N VERDUGO RD STE 250
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1546
Mailing Address - Country:US
Mailing Address - Phone:818-497-6004
Mailing Address - Fax:949-551-1281
Practice Address - Street 1:3436 N VERDUGO RD STE 250
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1546
Practice Address - Country:US
Practice Address - Phone:818-497-6004
Practice Address - Fax:949-551-1281
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor