Provider Demographics
NPI:1134266653
Name:PANANUSORN, MONTHIRAPORN (DC)
Entity type:Individual
Prefix:DR
First Name:MONTHIRAPORN
Middle Name:
Last Name:PANANUSORN
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 12241
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91224-0941
Mailing Address - Country:US
Mailing Address - Phone:626-617-3395
Mailing Address - Fax:626-457-8087
Practice Address - Street 1:917 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-4715
Practice Address - Country:US
Practice Address - Phone:626-617-3395
Practice Address - Fax:626-457-8087
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27505111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation