Provider Demographics
NPI:1881749562
Name:MEHTA, AMIT (DC)
Entity type:Individual
Prefix:DR
First Name:AMIT
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17401 VENTURA BLVD
Mailing Address - Street 2:SUITE A-29
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3860
Mailing Address - Country:US
Mailing Address - Phone:818-788-6817
Mailing Address - Fax:
Practice Address - Street 1:17401 VENTURA BLVD
Practice Address - Street 2:SUITE A-29
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3860
Practice Address - Country:US
Practice Address - Phone:818-788-6817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27484111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor