Provider Demographics
NPI:1902995053
Name:KAZANDJIAN, TSOLAG JIMMY (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:TSOLAG
Middle Name:JIMMY
Last Name:KAZANDJIAN
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 E ORANGE GROVE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1229
Mailing Address - Country:US
Mailing Address - Phone:818-500-9291
Mailing Address - Fax:818-660-2590
Practice Address - Street 1:265 E ORANGE GROVE AVE STE B
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502
Practice Address - Country:US
Practice Address - Phone:818-500-9291
Practice Address - Fax:818-660-2590
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12433171100000X
CADC30283111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20486OtherMEDICARE GROUP ID
CAV11539Medicare UPIN
CAWDC30283 AMedicare PIN