Provider Demographics
NPI:1871651976
Name:ADVANCED CHIROPRACTIC SOLUTIONS
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC SOLUTIONS
Other - Org Name:AAA CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAHNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIMZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-501-5553
Mailing Address - Street 1:17777 VENTURA BLVD STE 120
Mailing Address - Street 2:#120
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3738
Mailing Address - Country:US
Mailing Address - Phone:818-654-8320
Mailing Address - Fax:818-654-8321
Practice Address - Street 1:17777 VENTURA BLVD STE 120
Practice Address - Street 2:#120
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3738
Practice Address - Country:US
Practice Address - Phone:818-654-8320
Practice Address - Fax:818-654-8321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24277111N00000X
CA24277111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty