MEDICARE: MOHAMMAD KHAKPOUR 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	111NN0400X	Neurology Chiropractor	7991	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	605946	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1578697728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMMAD KHAKPOUR D.C.

Provider Business Mailing Address
First Line	:	13410 PRESTON RD
Second Line	:	STE 1-129
City	:	DALLAS
State	:	TX
Zip	:	75240-5299
Country	:	US
Telephone Number	:	972-503-6325
Fax Number	:	972-503-1954

Provider Business Practice Location Address
First Line	:	13021 COIT RD
Second Line	:	STE106
City	:	DALLAS
State	:	TX
Zip	:	75240-5789
Country	:	US
Telephone Number	:	972-503-6325
Fax Number	:	972-503-1954

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

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	07/08/2007

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