Provider Demographics
NPI:1366167561
Name:POURDEHGHAN CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:POURDEHGHAN CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARSHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:POURDEHGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-427-9776
Mailing Address - Street 1:6600 WOODLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-3420
Mailing Address - Country:US
Mailing Address - Phone:818-923-8150
Mailing Address - Fax:
Practice Address - Street 1:16250 VENTURA BLVD STE 225
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2283
Practice Address - Country:US
Practice Address - Phone:818-427-9776
Practice Address - Fax:888-388-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty