MEDICARE: DR. GOUDARZ VASSIGH 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	5608	AZ

General Provider Information

NPI Number	:	1437365301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GOUDARZ VASSIGH DC

Provider Business Mailing Address
First Line	:	4425 N 24TH ST
Second Line	:	STE 125
City	:	PHOENIX
State	:	AZ
Zip	:	85016-5596
Country	:	US
Telephone Number	:	602-956-8222
Fax Number	:	602-956-8333

Provider Business Practice Location Address
First Line	:	4425 N 24TH ST
Second Line	:	STE 125
City	:	PHOENIX
State	:	AZ
Zip	:	85016-5596
Country	:	US
Telephone Number	:	602-956-8222
Fax Number	:	602-956-8333

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	10/15/2020

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