Provider Demographics
NPI:1740201821
Name:SHAZADEH-SAFAVI, SEYED ABDOLHOSSEIN (DC)
Entity Type:Individual
Prefix:
First Name:SEYED ABDOLHOSSEIN
Middle Name:
Last Name:SHAZADEH-SAFAVI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:SEYED A.
Other - Middle Name:
Other - Last Name:SHAZADEH-SAFAVI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3441 W BALL RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3723
Mailing Address - Country:US
Mailing Address - Phone:714-952-9553
Mailing Address - Fax:714-952-8782
Practice Address - Street 1:3441 W BALL RD
Practice Address - Street 2:SUITE E
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3723
Practice Address - Country:US
Practice Address - Phone:714-952-9553
Practice Address - Fax:714-952-8782
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16859111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT82636Medicare UPIN
CADC16859Medicare PIN