Provider Demographics
NPI:1447826052
Name:FAZEL CHIROPRACTIC, INC
Entity type:Organization
Organization Name:FAZEL CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FAZEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-782-8369
Mailing Address - Street 1:1819 S BAYLESS ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-3101
Mailing Address - Country:US
Mailing Address - Phone:951-782-8369
Mailing Address - Fax:951-782-8378
Practice Address - Street 1:3404 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3253
Practice Address - Country:US
Practice Address - Phone:951-782-8369
Practice Address - Fax:951-782-8378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty