Provider Demographics
NPI:1972704567
Name:ROBERT DARDASHTI, D.C. INCORPORATED
Entity type:Organization
Organization Name:ROBERT DARDASHTI, D.C. INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ELIA
Authorized Official - Last Name:DARDASHTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-789-5560
Mailing Address - Street 1:16661 VENTURA BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1914
Mailing Address - Country:US
Mailing Address - Phone:818-789-5560
Mailing Address - Fax:818-789-7025
Practice Address - Street 1:16661 VENTURA BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1914
Practice Address - Country:US
Practice Address - Phone:818-789-5560
Practice Address - Fax:818-789-7025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20870261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC20870Medicare PIN