Healthcare Provider Details

I. General information

NPI: 1174526859
Provider Name (Legal Business Name): SHAHROKH SHAHVERDI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 N GLEBE RD
ARLINGTON VA
22207-2262
US

IV. Provider business mailing address

2809 SCHAFFLIND CT
VIENNA VA
22180-7021
US

V. Phone/Fax

Practice location:
  • Phone: 703-522-8855
  • Fax: 703-522-4574
Mailing address:
  • Phone: 703-573-0031
  • Fax: 703-522-4574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number0104555755
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: