Provider Demographics
NPI:1811666969
Name:DIVINE HEALING CHIROPRACTIC MOUSAVI INC
Entity type:Organization
Organization Name:DIVINE HEALING CHIROPRACTIC MOUSAVI INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AZIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:657-221-5436
Mailing Address - Street 1:2010 E 1ST ST #270
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705
Mailing Address - Country:US
Mailing Address - Phone:415-828-9858
Mailing Address - Fax:714-888-4510
Practice Address - Street 1:2010 E 1ST ST #270
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705
Practice Address - Country:US
Practice Address - Phone:415-828-9858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-11
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty