Provider Demographics
NPI:1760529796
Name:SHADI ELIASPOUR DC
Entity Type:Organization
Organization Name:SHADI ELIASPOUR DC
Other - Org Name:ADVANCED HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHADI
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIASPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-999-0202
Mailing Address - Street 1:PO BOX 573332
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-3332
Mailing Address - Country:US
Mailing Address - Phone:818-999-0202
Mailing Address - Fax:818-999-0212
Practice Address - Street 1:20969 VENTURA BLVD STE 23
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-6634
Practice Address - Country:US
Practice Address - Phone:818-999-0202
Practice Address - Fax:818-999-0212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC29124Medicare ID - Type Unspecified