Provider Demographics
NPI:1164825659
Name:SORAYA CHIROPRACTIC CARE INC
Entity type:Organization
Organization Name:SORAYA CHIROPRACTIC CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:SORAYA
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:310-467-5218
Mailing Address - Street 1:959 S MULLEN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-1829
Mailing Address - Country:US
Mailing Address - Phone:310-467-5218
Mailing Address - Fax:310-933-0559
Practice Address - Street 1:2121 AVENUE OF THE STARS
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-5010
Practice Address - Country:US
Practice Address - Phone:310-467-5218
Practice Address - Fax:310-933-0559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30645111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty