MEDICARE: MRS. MARJANEH GHASSEMITARI D.C.

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	8505	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	H060813101	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1386652352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARJANEH GHASSEMITARI D.C.

Provider Business Mailing Address
First Line	:	P.O. BOX 868058
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75086-8058
Country	:	US
Telephone Number	:	214-738-2170
Fax Number	:	817-963-8896

Provider Business Practice Location Address
First Line	:	2600 K AVE #136
Second Line	:	136
City	:	PLANO
State	:	TX
Zip	:	75074-5306
Country	:	US
Telephone Number	:	214-738-2170
Fax Number	:	817-963-8896

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	10/21/2021

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