Healthcare Provider Details

I. General information

NPI: 1295140838
Provider Name (Legal Business Name): SEYED REZA EFTEKHAR HOSSEINI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4810 MANHEIM AVE
BELTSVILLE MD
20705-1821
US

IV. Provider business mailing address

7011 CALAMO ST SUITE 208
SPRINGFIELD VA
22150-3500
US

V. Phone/Fax

Practice location:
  • Phone: 703-678-9726
  • Fax:
Mailing address:
  • Phone: 703-678-9726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104557178
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: