MEDICARE: EHSAN IZADI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	14968	TX

General Provider Information

NPI Number	:	1306598719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EHSAN IZADI

Provider Business Mailing Address
First Line	:	908 ASBURY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-5149
Country	:	US
Telephone Number	:	832-495-1913
Fax Number	:

Provider Business Practice Location Address
First Line	:	908 ASBURY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-5149
Country	:	US
Telephone Number	:	832-495-1913
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2022
Last Update Date	:	04/21/2023

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Directions to “ EHSAN IZADI ” Practice Location

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