Provider Demographics
NPI:1740480615
Name:DR. ARMEN B. AGACANYAN DC CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:DR. ARMEN B. AGACANYAN DC CHIROPRACTIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AGACANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-779-3565
Mailing Address - Street 1:18525 SUTTER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-2899
Mailing Address - Country:US
Mailing Address - Phone:408-779-3565
Mailing Address - Fax:408-779-9810
Practice Address - Street 1:18525 SUTTER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-2899
Practice Address - Country:US
Practice Address - Phone:408-779-3565
Practice Address - Fax:408-779-9810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1902850100OtherNPI TYPE I
CA1902850100OtherNPI TYPE I