Provider Demographics
NPI:1780753194
Name:GOSHTASBI CHIROPRACTIC INC
Entity type:Organization
Organization Name:GOSHTASBI CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BAHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSHTASBI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-283-2225
Mailing Address - Street 1:2950 N GLASSELL ST
Mailing Address - Street 2:A
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-1078
Mailing Address - Country:US
Mailing Address - Phone:714-283-2225
Mailing Address - Fax:
Practice Address - Street 1:2950 N GLASSELL ST
Practice Address - Street 2:A
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-1078
Practice Address - Country:US
Practice Address - Phone:714-283-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 27073111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0270730OtherBLUE SHIELD
CADC0270730OtherBLUE SHIELD