Provider Demographics
NPI:1922057033
Name:MATIN, LOUJAN J (DC)
Entity Type:Individual
Prefix:DR
First Name:LOUJAN
Middle Name:J
Last Name:MATIN
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 1:3661 TORRANCE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4884
Mailing Address - Country:US
Mailing Address - Phone:310-540-9796
Mailing Address - Fax:310-316-6195
Practice Address - Street 1:3661 TORRANCE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4884
Practice Address - Country:US
Practice Address - Phone:310-540-9796
Practice Address - Fax:310-316-6195
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH 115 CHO882Medicaid
SCGCH 115 CHO882Medicaid