=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881818060
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAHIN BANOU BEIRAGHDAR DC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2007
-----------------------------------------------------
Last Update Date | 08/05/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4123 CONNECTICUT AVE NW
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20008-1155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-265-6000
-----------------------------------------------------
Fax | 202-265-6018
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5824
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20016-1424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-265-6000
-----------------------------------------------------
Fax | 202-265-6018
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MAHIN BANOU BEIRAGHDAR
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 202-265-6000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 000072880
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------