Provider Demographics
NPI:1891933586
Name:OPTIMUM HEALTH CHIROPRACTIC
Entity Type:Organization
Organization Name:OPTIMUM HEALTH CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GAGIK
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVANDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-704-1662
Mailing Address - Street 1:20335 VENTURA BLVD
Mailing Address - Street 2:STE. 108
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2444
Mailing Address - Country:US
Mailing Address - Phone:818-704-1662
Mailing Address - Fax:818-884-6795
Practice Address - Street 1:20335 VENTURA BLVD
Practice Address - Street 2:STE. 108
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2444
Practice Address - Country:US
Practice Address - Phone:818-704-1662
Practice Address - Fax:818-884-6795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ54798YOtherBLUE SHIELD OF CA
CADC26266Medicare PIN