Provider Demographics
NPI:1992839385
Name:MITRA RAZIPOUR CHIROPRACTIC PROFESSIONAL CORP
Entity Type:Organization
Organization Name:MITRA RAZIPOUR CHIROPRACTIC PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MITRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZIPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-992-5252
Mailing Address - Street 1:20969 VENTURA BLVD
Mailing Address - Street 2:STE 23
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2305
Mailing Address - Country:US
Mailing Address - Phone:818-992-5252
Mailing Address - Fax:818-992-5292
Practice Address - Street 1:20969 VENTURA BLVD
Practice Address - Street 2:STE 23
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2305
Practice Address - Country:US
Practice Address - Phone:818-992-5252
Practice Address - Fax:818-992-5292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC29373Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID