Provider Demographics
NPI:1811225642
Name:KHORRAMI, MARJAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARJAN
Middle Name:
Last Name:KHORRAMI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 CAMPTON PL
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4732
Mailing Address - Country:US
Mailing Address - Phone:949-218-0145
Mailing Address - Fax:
Practice Address - Street 1:34 CAMPTON PL
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-4732
Practice Address - Country:US
Practice Address - Phone:949-218-0145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31376111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor