MEDICARE: DR. ROYA MOLAEI 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	111N00000X	Chiropractor	0104001592	VA

General Provider Information

NPI Number	:	1174714174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROYA MOLAEI D.C.

Provider Business Mailing 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

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	:	08/05/2007
Last Update Date	:	08/05/2007

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