Provider Demographics
NPI:1780840827
Name:ISSAGHOLIANTCE, PATRICK (DC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:ISSAGHOLIANTCE
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 1:2222 W BURBANK BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1279
Mailing Address - Country:US
Mailing Address - Phone:818-846-1441
Mailing Address - Fax:
Practice Address - Street 1:2222 W BURBANK BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1279
Practice Address - Country:US
Practice Address - Phone:818-846-1441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor