Provider Demographics
NPI:1811941099
Name:GHAZALI, SHAHNAZ (DC)
Entity type:Individual
Prefix:
First Name:SHAHNAZ
Middle Name:
Last Name:GHAZALI
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 1:150 N ROBERTSON BLVD
Mailing Address - Street 2:350
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2142
Mailing Address - Country:US
Mailing Address - Phone:310-360-7670
Mailing Address - Fax:310-360-7670
Practice Address - Street 1:150 N ROBERTSON BLVD
Practice Address - Street 2:350
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2142
Practice Address - Country:US
Practice Address - Phone:310-360-7670
Practice Address - Fax:310-360-7670
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARDC26865OtherLICENSE
ARDC26865OtherLICENSE
CADC26865Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER