Provider Demographics
NPI:1780924779
Name:ADIBI, ELINA (DC)
Entity type:Individual
Prefix:
First Name:ELINA
Middle Name:
Last Name:ADIBI
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 1:1016 S ROBERTSON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1505
Mailing Address - Country:US
Mailing Address - Phone:310-652-9283
Mailing Address - Fax:310-652-9292
Practice Address - Street 1:1016 S ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1505
Practice Address - Country:US
Practice Address - Phone:310-652-9283
Practice Address - Fax:310-652-9292
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA658490111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA65490OtherLICENSE NUMBER
CAA65490OtherLICENSE NUMBER