Provider Demographics
NPI:1720381478
Name:POOYANDEH CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:POOYANDEH CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RASOUL
Authorized Official - Middle Name:
Authorized Official - Last Name:POOYANDEH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:909-620-5699
Mailing Address - Street 1:502 W HOLT AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-3604
Mailing Address - Country:US
Mailing Address - Phone:909-620-5699
Mailing Address - Fax:909-620-5799
Practice Address - Street 1:502 W.HOLT AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768
Practice Address - Country:US
Practice Address - Phone:909-620-5699
Practice Address - Fax:909-620-5799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27512111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty