Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 10834 | TX |
NPI | 1063817534 |
---|---|
Provider Name | Dr. Kourosh Golban |
First Address | Houston, TX 77019-3500 |
Second Address | Houston, TX 77063-3626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2014 |
Last Update Date | 27/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10834 | TEXAS BOARD OF CIROPRACTIC EXAMINERS (01) | TX |