MEDICARE: DR. FARID SAMADZADA DC

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	5115	TX

General Provider Information

NPI Number	:	1558391797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FARID SAMADZADA DC

Provider Business Mailing Address
First Line	:	6336 GASTON AVE
Second Line	:	LAKEWOOD CHIROPRACTIC CLINIC
City	:	DALLAS
State	:	TX
Zip	:	75214
Country	:	US
Telephone Number	:	214-824-7000
Fax Number	:	214-824-7031

Provider Business Practice Location Address
First Line	:	6336 GASTON AVE
Second Line	:	LAKEWOOD CHIROPRACTIC CLINIC
City	:	DALLAS
State	:	TX
Zip	:	75214
Country	:	US
Telephone Number	:	214-824-7000
Fax Number	:	214-824-7031

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	07/08/2007

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