Provider Demographics
NPI:1982926218
Name:MARJAN KHORRAMI CHIROPRACTIC WELLNESS INC
Entity Type:Organization
Organization Name:MARJAN KHORRAMI CHIROPRACTIC WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHORRAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-770-0128
Mailing Address - Street 1:23412 MOULTON PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1743
Mailing Address - Country:US
Mailing Address - Phone:949-770-0128
Mailing Address - Fax:949-829-0221
Practice Address - Street 1:23412 MOULTON PKWY STE 120
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1743
Practice Address - Country:US
Practice Address - Phone:949-770-0128
Practice Address - Fax:949-829-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31376111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty