Provider Demographics
NPI:1720606700
Name:KHALILI, CYRUS (DC)
Entity Type:Individual
Prefix:DR
First Name:CYRUS
Middle Name:
Last Name:KHALILI
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 1:324 WHISPERING TRL
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-0801
Mailing Address - Country:US
Mailing Address - Phone:562-217-9019
Mailing Address - Fax:562-864-6899
Practice Address - Street 1:504 S BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-2416
Practice Address - Country:US
Practice Address - Phone:562-217-9019
Practice Address - Fax:562-864-6899
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28802111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor