Provider Demographics
NPI:1982636080
Name:IRANIPOUR, CYRUS (DC)
Entity Type:Individual
Prefix:DR
First Name:CYRUS
Middle Name:
Last Name:IRANIPOUR
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:PO BOX 52322
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-2322
Mailing Address - Country:US
Mailing Address - Phone:909-890-9494
Mailing Address - Fax:909-890-9333
Practice Address - Street 1:228 W HOSPITALITY LN
Practice Address - Street 2:SUITE F1
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3268
Practice Address - Country:US
Practice Address - Phone:909-890-9494
Practice Address - Fax:909-890-9333
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23660111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0236620Medicare ID - Type Unspecified