Provider Demographics
NPI:1649347089
Name:PESSARAN, DAVID Y (BA, DC, QME)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:Y
Last Name:PESSARAN
Suffix:
Gender:M
Credentials:BA, DC, QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6830 ANTELOPE RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621-1977
Mailing Address - Country:US
Mailing Address - Phone:916-723-8272
Mailing Address - Fax:916-723-0688
Practice Address - Street 1:6830 ANTELOPE RD
Practice Address - Street 2:SUITE J
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-1977
Practice Address - Country:US
Practice Address - Phone:916-723-8272
Practice Address - Fax:916-723-0688
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 14466111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT05383Medicare UPIN