Provider Demographics
NPI:1669614426
Name:AZIZI, KHALED (DC)
Entity type:Individual
Prefix:
First Name:KHALED
Middle Name:
Last Name:AZIZI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 N WIGET LN
Mailing Address - Street 2:130
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2435
Mailing Address - Country:US
Mailing Address - Phone:925-935-5425
Mailing Address - Fax:925-947-2671
Practice Address - Street 1:325 N WIGET LN
Practice Address - Street 2:130
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2435
Practice Address - Country:US
Practice Address - Phone:925-935-5425
Practice Address - Fax:925-947-2671
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27718111N00000X, 111NN1001X, 111NR0400X, 111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NX0100XChiropractic ProvidersChiropractorOccupational Health