Provider Demographics
NPI:1982867586
Name:SUPERIOR CHIROPRACTIC CARE
Entity Type:Organization
Organization Name:SUPERIOR CHIROPRACTIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIVA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKHSHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-902-2122
Mailing Address - Street 1:PO BOX 251
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-0251
Mailing Address - Country:US
Mailing Address - Phone:818-902-2122
Mailing Address - Fax:818-902-2151
Practice Address - Street 1:14328 VICTORY BLVD
Practice Address - Street 2:#G
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1946
Practice Address - Country:US
Practice Address - Phone:818-902-2122
Practice Address - Fax:818-902-2151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23513111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U55034Medicare UPIN