=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942404231
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARYAM JAFARIEH DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2007
-----------------------------------------------------
Last Update Date | 11/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1919 NE 45TH ST STE 219
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33308-5136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-229-1995
-----------------------------------------------------
Fax | 954-667-7954
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5165 NW 11TH LN
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33064-8621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-554-4662
-----------------------------------------------------
Fax | 954-229-1996
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH8598
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------