Provider Demographics
NPI:1033697743
Name:FRANK PANOUSSI CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:FRANK PANOUSSI CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:PANOUSSI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:661-273-1101
Mailing Address - Street 1:38344 30TH ST E
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4935
Mailing Address - Country:US
Mailing Address - Phone:661-273-1101
Mailing Address - Fax:661-273-2657
Practice Address - Street 1:38344 30TH ST E
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4935
Practice Address - Country:US
Practice Address - Phone:661-273-1101
Practice Address - Fax:661-273-2657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23943111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty