Provider Demographics
NPI:1972057602
Name:RAIHAN, ADNAN (DC)
Entity Type:Individual
Prefix:
First Name:ADNAN
Middle Name:
Last Name:RAIHAN
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 1:30012 IVY GLENN DR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5005
Mailing Address - Country:US
Mailing Address - Phone:949-582-9090
Mailing Address - Fax:
Practice Address - Street 1:30012 IVY GLENN DR
Practice Address - Street 2:SUITE 170
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-5005
Practice Address - Country:US
Practice Address - Phone:949-582-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor