Provider Demographics
NPI:1659473734
Name:FARAHANCHI, ALI (MS DC)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:FARAHANCHI
Suffix:
Gender:M
Credentials:MS DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2883 MEADE AVE
Mailing Address - Street 2:# B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4211
Mailing Address - Country:US
Mailing Address - Phone:619-298-2342
Mailing Address - Fax:619-298-7215
Practice Address - Street 1:803 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-298-2342
Practice Address - Fax:619-298-7215
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25862111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0258620Medicaid
CADC0258620Medicaid
U76123Medicare UPIN