Healthcare Provider Details

I. General information

NPI: 1396748679
Provider Name (Legal Business Name): MOHSEN SAMADIAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6430 RICHMOND AVE STE 220
HOUSTON TX
77057-5918
US

IV. Provider business mailing address

6430 RICHMOND AVE STE 220
HOUSTON TX
77057-5918
US

V. Phone/Fax

Practice location:
  • Phone: 713-532-8575
  • Fax:
Mailing address:
  • Phone: 713-532-8575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8859
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: