MEDICARE: DR. RAHIMA KASSAM P.A.

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	111NR0400X	Rehabilitation Chiropractor	9893	TX

General Provider Information

NPI Number	:	1669517942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. RAHIMA KASSAM P.A.

Provider Business Mailing Address
First Line	:	PO BOX 630523
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-0129
Country	:	US
Telephone Number	:	214-574-4255
Fax Number	:	214-351-4254

Provider Business Practice Location Address
First Line	:	3530 FOREST LN
Second Line	:	SUITE 245
City	:	DALLAS
State	:	TX
Zip	:	75234-7910
Country	:	US
Telephone Number	:	214-574-4255
Fax Number	:	214-351-4254

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	DR. RAHIMA KASSAM
Credential	:	D.C.
Telephone Number	:	214-574-4255

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	10/29/2007

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