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General NPI Number Information
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NPI Number | 1396903605
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Entity Type | Individual
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Provider Name | ESMAEEL SAMALIAZAD DC
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Gender | Male
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Dates
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Enumeration Date | 05/23/2008
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Last Update Date | 03/18/2010
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Provider Practice Location Address
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Address Line | 1953 COLONIAL BLVD
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City | FORT MYERS
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State | FL
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Zip | 33907-1302
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Country | US
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Telephone | 239-277-9552
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Fax | 239-277-7366
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Provider Business Mailing Address
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Address Line | 1953 COLONIAL BLVD
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City | FORT MYERS
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State | FL
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Zip | 33907-1302
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Country | US
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Telephone | 239-277-9552
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Fax | 239-277-7366
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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 | CH8642
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License Number State | FL
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