Provider Demographics
NPI:1679780076
Name:BASSIRI & HUIZENGA CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:BASSIRI & HUIZENGA CHIROPRACTIC CORPORATION
Other - Org Name:TOLUCA LAKE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENA
Authorized Official - Middle Name:K
Authorized Official - Last Name:LAROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-506-5325
Mailing Address - Street 1:10112 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2518
Mailing Address - Country:US
Mailing Address - Phone:818-506-5325
Mailing Address - Fax:818-506-1739
Practice Address - Street 1:10112 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-2518
Practice Address - Country:US
Practice Address - Phone:818-506-5325
Practice Address - Fax:818-506-1739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID
CAW13165Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER