MEDICARE: DR. SHAHROKH SHAHVERDI D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	0104555755	VA

General Provider Information

NPI Number	:	1174526859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAHROKH SHAHVERDI D.C.

Provider Business Mailing Address
First Line	:	2809 SCHAFFLIND CT
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22180-7021
Country	:	US
Telephone Number	:	703-573-0031
Fax Number	:	703-522-4574

Provider Business Practice Location Address
First Line	:	2160 N GLEBE RD
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22207-2262
Country	:	US
Telephone Number	:	703-522-8855
Fax Number	:	703-522-4574

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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