Provider Demographics
NPI:1295862746
Name:NILOOFAR NICOLE JAVAHERIANA CHIROCARE
Entity type:Organization
Organization Name:NILOOFAR NICOLE JAVAHERIANA CHIROCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:NILOOFAR
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:JAVAHERIANA
Authorized Official - Suffix:
Authorized Official - Credentials:CHIROPRACTOR
Authorized Official - Phone:818-995-4481
Mailing Address - Street 1:16101 VENTURA BLVD
Mailing Address - Street 2:SUT 328
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436
Mailing Address - Country:US
Mailing Address - Phone:818-995-4481
Mailing Address - Fax:818-907-8648
Practice Address - Street 1:16101 VENTURA BLVD
Practice Address - Street 2:SUT 328
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436
Practice Address - Country:US
Practice Address - Phone:818-995-4481
Practice Address - Fax:818-907-8648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty