Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC27718 | CA |
N | 111NN1001X | Nutrition | DC27718 | CA |
N | 111NR0400X | Rehabilitation Chiropractor | DC27718 | CA |
N | 111NX0100X | Occupational Health | DC27718 | CA |
NPI | 1669614426 |
---|---|
Provider Name | Khaled Azizi |
First Address | Walnut Creek, CA 94598-2435 |
Second Address | Walnut Creek, CA 94598-2435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2009 |
Last Update Date | 25/03/2009 |