Provider Demographics
NPI:1245372408
Name:SOHEIL MEHDIZADEH CHIROPRACTIC CORP.
Entity type:Organization
Organization Name:SOHEIL MEHDIZADEH CHIROPRACTIC CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:SOHEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHDIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DC, IDE, QME
Authorized Official - Phone:310-704-4757
Mailing Address - Street 1:2105 BEVERLY BLVD
Mailing Address - Street 2:SUITE# 207
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2216
Mailing Address - Country:US
Mailing Address - Phone:310-704-4757
Mailing Address - Fax:310-734-7567
Practice Address - Street 1:2105 BEVERLY BLVD
Practice Address - Street 2:SUITE# 207
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2216
Practice Address - Country:US
Practice Address - Phone:310-704-4757
Practice Address - Fax:310-734-7567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 25086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty