Provider Demographics
NPI:1821410622
Name:GUREGHIAN, RAFFI KHACHIK (DC)
Entity Type:Individual
Prefix:
First Name:RAFFI
Middle Name:KHACHIK
Last Name:GUREGHIAN
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 1:10510 VICTORY BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3961
Mailing Address - Country:US
Mailing Address - Phone:818-755-9977
Mailing Address - Fax:818-755-9917
Practice Address - Street 1:10510 VICTORY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3961
Practice Address - Country:US
Practice Address - Phone:818-755-9977
Practice Address - Fax:818-755-9917
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32697111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor