Provider Demographics
NPI:1831249952
Name:FARAHMAND, FARZAD (CHIROPRACTOR DC)
Entity type:Individual
Prefix:MR
First Name:FARZAD
Middle Name:
Last Name:FARAHMAND
Suffix:
Gender:M
Credentials:CHIROPRACTOR DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16661 VENTURA BLVD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436
Mailing Address - Country:US
Mailing Address - Phone:818-288-2220
Mailing Address - Fax:818-501-2000
Practice Address - Street 1:16661 VENTURA BLVD
Practice Address - Street 2:SUITE 403
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436
Practice Address - Country:US
Practice Address - Phone:818-288-2220
Practice Address - Fax:818-501-2000
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC29582OtherBCBS
DC29582Medicare UPIN
CADC29582OtherBCBS