Provider Demographics
NPI:1992863245
Name:GOLEH, SHADI (DC)
Entity Type:Individual
Prefix:DR
First Name:SHADI
Middle Name:
Last Name:GOLEH
Suffix:
Gender:F
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 573332
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357
Mailing Address - Country:US
Mailing Address - Phone:818-343-0303
Mailing Address - Fax:818-999-0212
Practice Address - Street 1:19100 VENTURA BLVD
Practice Address - Street 2:#10
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3239
Practice Address - Country:US
Practice Address - Phone:818-343-0303
Practice Address - Fax:818-343-0300
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC29124Medicare UPIN