=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447732524
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARIAN AZODI DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2018
-----------------------------------------------------
Last Update Date | 01/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22911 CLAY RD STE 400
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77449-8202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-437-7380
-----------------------------------------------------
Fax | 832-437-7385
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22438 CORIANDER DR
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77450-1520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-613-3812
-----------------------------------------------------
Fax | 832-437-7385
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 13764
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------