Provider Demographics
NPI:1710175682
Name:MIRZAIANS CHIROPRACTIC & PHYSICAL REHABILITATION SERVICES, INC.
Entity Type:Organization
Organization Name:MIRZAIANS CHIROPRACTIC & PHYSICAL REHABILITATION SERVICES, INC.
Other - Org Name:PHYSICAL REHABILITATION SERVICES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARBI
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRZAIANS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-537-7600
Mailing Address - Street 1:3680 E IMPERIAL HWY STE 240
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-2673
Mailing Address - Country:US
Mailing Address - Phone:310-537-7600
Mailing Address - Fax:310-537-9438
Practice Address - Street 1:3680 E IMPERIAL HWY STE 240
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2673
Practice Address - Country:US
Practice Address - Phone:310-537-7600
Practice Address - Fax:310-537-9438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29482111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty