Provider Demographics
NPI:1750668919
Name:KESHISHIAN CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:KESHISHIAN CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VAHAGN
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:KESHISHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-991-4685
Mailing Address - Street 1:5887 KANAN RD
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-1651
Mailing Address - Country:US
Mailing Address - Phone:818-991-4685
Mailing Address - Fax:818-991-2603
Practice Address - Street 1:5887 KANAN RD
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-1651
Practice Address - Country:US
Practice Address - Phone:818-991-4685
Practice Address - Fax:818-991-2603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-25153111N00000X
CADC-24441111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5056Medicare UPIN
CADC25153Medicare PIN