Healthcare Provider Details

I. General information

NPI: 1760417927
Provider Name (Legal Business Name): ELHAM KAIVAN-MEHR DC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 MEDICAL PKWY SUITE 208
DALLAS TX
75234-7859
US

IV. Provider business mailing address

8 MEDICAL PKWY SUITE 208
DALLAS TX
75234-7859
US

V. Phone/Fax

Practice location:
  • Phone: 972-701-8181
  • Fax: 972-701-8182
Mailing address:
  • Phone: 972-701-8181
  • Fax: 972-701-8182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9455
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: