Provider Demographics
NPI:1972834596
Name:AMIT MEHTA CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:AMIT MEHTA CHIROPRACTIC CORPORATION
Other - Org Name:MEHTA FAMILY HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-788-6817
Mailing Address - Street 1:PO BOX 261353
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91426-1353
Mailing Address - Country:US
Mailing Address - Phone:818-788-6817
Mailing Address - Fax:818-464-0138
Practice Address - Street 1:17401 VENTURA BLVD
Practice Address - Street 2:SUITE A-30
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3860
Practice Address - Country:US
Practice Address - Phone:818-788-6817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADJ620AMedicare PIN
CAWDC27484AMedicare PIN