Provider Demographics
NPI:1952344855
Name:NAZARIAN, VICTOR M (DC)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:M
Last Name:NAZARIAN
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 1:10921 WILSHIRE BLVD
Mailing Address - Street 2:STE 801
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4003
Mailing Address - Country:US
Mailing Address - Phone:310-209-0425
Mailing Address - Fax:310-209-0495
Practice Address - Street 1:10921 WILSHIRE BLVD
Practice Address - Street 2:SUITE# 801
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3906
Practice Address - Country:US
Practice Address - Phone:310-209-0425
Practice Address - Fax:310-209-0495
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23926111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0239260OtherBLUE SHIELD
CAU59038Medicare UPIN
CADC0239260OtherBLUE SHIELD