MEDICARE: DR. MOHSEN SAMADIAN DC

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	8859	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	606417	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1396748679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHSEN SAMADIAN DC

Provider Business Mailing Address
First Line	:	6430 RICHMOND AVE
Second Line	:	STE 220
City	:	HOUSTON
State	:	TX
Zip	:	77057-5918
Country	:	US
Telephone Number	:	713-532-8575
Fax Number	:

Provider Business Practice Location Address
First Line	:	6430 RICHMOND AVE
Second Line	:	STE 220
City	:	HOUSTON
State	:	TX
Zip	:	77057-5918
Country	:	US
Telephone Number	:	713-532-8575
Fax Number	:

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. MOHSEN SAMADIAN DC” Practice Location

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