Healthcare Provider Details

I. General information

NPI: 1700476231
Provider Name (Legal Business Name): KIANOOSH ZIAYAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 SE CENTRAL PKWY
STUART FL
34994-3970
US

IV. Provider business mailing address

626 SE CENTRAL PKWY
STUART FL
34994-3970
US

V. Phone/Fax

Practice location:
  • Phone: 772-223-9597
  • Fax:
Mailing address:
  • Phone: 772-223-9597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00779700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH13894
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: