Provider Demographics
NPI:1841593217
Name:OMID JAVAHERIAN CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:OMID JAVAHERIAN CHIROPRACTIC LLC
Other - Org Name:METRO CHIRO CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OMID
Authorized Official - Middle Name:M
Authorized Official - Last Name:JAVAHERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-995-4614
Mailing Address - Street 1:16430 VENTURA BLVD
Mailing Address - Street 2:SUITE #106
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2115
Mailing Address - Country:US
Mailing Address - Phone:818-995-4616
Mailing Address - Fax:
Practice Address - Street 1:16430 VENTURA BLVD.
Practice Address - Street 2:SUITE #106
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436
Practice Address - Country:US
Practice Address - Phone:818-995-4614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23177OtherMEDICARE PTAN