Rusudan Dediashvili, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

D.C. 25561 Issued in CA

Practice address

13760 Victory Blvd
Van Nuys, CA 91401-2324

Phone

(818) 922-7713

Fax

(323) 965-1411

NPI assigned

Aug 9, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Chiropractic

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rusudan Dediashvili Chiropractic Corp.

  • Chiropractor
  • Van Nuys, CA
  • NPI 1770756892
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410998400000",
    "number": "1134311509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13760 VICTORY BLVD",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914012324",
            "telephone_number": "818-922-7713",
            "fax_number": "323-965-1411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13760 VICTORY BLVD",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914012324",
            "telephone_number": "818-922-7713",
            "fax_number": "323-965-1411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEDIASHVILI",
        "first_name": "RUSUDAN",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-09",
        "last_updated": "2014-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "D.C. 25561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Van Nuys, CA
• Providers in Van Nuys, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.