Provider Demographics
NPI:1841468154
Name:AZITA BANOONI CHIROPRACTIC INC
Entity type:Organization
Organization Name:AZITA BANOONI CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AZITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANOONI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:323-549-0822
Mailing Address - Street 1:5455 WILSHIRE BLVD
Mailing Address - Street 2:#806
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036
Mailing Address - Country:US
Mailing Address - Phone:323-549-0822
Mailing Address - Fax:323-549-0826
Practice Address - Street 1:5455 WILSHIRE BLVD
Practice Address - Street 2:#806
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036
Practice Address - Country:US
Practice Address - Phone:323-549-0822
Practice Address - Fax:323-549-0826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAO55507Medicare UPIN