Healthcare Provider Details

I. General information

NPI: 1669896221
Provider Name (Legal Business Name): ALI ROUNAGHI D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5174 CENTRAL AVE NE
COLUMBIA HEIGHTS MN
55421-2258
US

IV. Provider business mailing address

5174 CENTRAL AVE NE
COLUMBIA HEIGHTS MN
55421-2258
US

V. Phone/Fax

Practice location:
  • Phone: 651-331-1460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number5833
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: