Provider Demographics
NPI:1720361132
Name:POURTEYMOOR, NAHDIR (DC)
Entity Type:Individual
Prefix:MR
First Name:NAHDIR
Middle Name:
Last Name:POURTEYMOOR
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 1:29000 S WESTERN AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-0818
Mailing Address - Country:US
Mailing Address - Phone:310-514-0277
Mailing Address - Fax:
Practice Address - Street 1:29000 S WESTERN AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-0818
Practice Address - Country:US
Practice Address - Phone:310-514-0277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32034111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor