Provider Demographics
NPI:1730351123
Name:ROFAGHA CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:ROFAGHA CHIROPRACTIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAZEE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROFAGHA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:626-583-9116
Mailing Address - Street 1:1017 S FAIR OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2621
Mailing Address - Country:US
Mailing Address - Phone:626-583-9116
Mailing Address - Fax:626-403-6266
Practice Address - Street 1:1017 S FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2621
Practice Address - Country:US
Practice Address - Phone:626-583-9116
Practice Address - Fax:626-403-6266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19495Medicare PIN