Provider Demographics
NPI:1750424487
Name:KESHISHIAN, MELINA (DC)
Entity type:Individual
Prefix:
First Name:MELINA
Middle Name:
Last Name:KESHISHIAN
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 1:5887 KANAN RD
Mailing Address - Street 2:
Mailing Address - City:AGOURA
Mailing Address - State:CA
Mailing Address - Zip Code:91301-1651
Mailing Address - Country:US
Mailing Address - Phone:818-991-9379
Mailing Address - Fax:
Practice Address - Street 1:5887 KANAN RD
Practice Address - Street 2:
Practice Address - City:AGOURA
Practice Address - State:CA
Practice Address - Zip Code:91301-1651
Practice Address - Country:US
Practice Address - Phone:818-991-9379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24441111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA24441OtherPIN NUMBER