MEDICARE: MAHLA MOHSENZADEH

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	4276	OK

General Provider Information

NPI Number	:	1760009229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHLA MOHSENZADEH

Provider Business Mailing Address
First Line	:	6708 NW 123RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73142-3109
Country	:	US
Telephone Number	:	405-414-8376
Fax Number	:

Provider Business Practice Location Address
First Line	:	6442 AVONDALE DR
Second Line	:
City	:	NICHOLS HILLS
State	:	OK
Zip	:	73116-6404
Country	:	US
Telephone Number	:	405-286-1259
Fax Number	:

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

Provider Enumeration Date	:	07/01/2020
Last Update Date	:	06/30/2021

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Directions to “ MAHLA MOHSENZADEH ” Practice Location

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