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General NPI Number Information
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NPI Number | 1295915205
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Entity Type | Individual
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Provider Name | IRAJ VAHEDIPOUR D.C.
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Gender | Male
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 12/16/2011
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Provider Practice Location Address
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Address Line | 5414 FOREST LN
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City | DALLAS
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State | TX
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Zip | 75244-8008
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Country | US
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Telephone | 972-503-2273
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Fax | 972-503-0336
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Provider Business Mailing Address
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Address Line | 5414 FOREST LN
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City | DALLAS
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State | TX
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Zip | 75244-8008
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Country | US
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Telephone | 972-503-2273
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Fax | 972-503-0336
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 10636
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License Number State | TX
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