MEDICARE: ACTIVE CHIROPRATIC

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

General Provider Information

NPI Number	:	1609144690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE CHIROPRATIC

Provider Business Mailing Address
First Line	:	8001 LBJ FWY STE 401
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-1383
Country	:	US
Telephone Number	:	972-897-8829
Fax Number	:

Provider Business Practice Location Address
First Line	:	8001 LBJ FWY STE 401
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-1383
Country	:	US
Telephone Number	:	972-897-8829
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FARID AMINZADEH
Credential	:
Telephone Number	:	972-897-8829

Provider Enumeration Date	:	12/06/2011
Last Update Date	:	12/06/2011

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Directions to “ACTIVE CHIROPRATIC ” Practice Location

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