Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 0104555755 | VA |
NPI | 1174526859 |
---|---|
Provider Name | Dr. Shahrokh Shahverdi |
First Address | Vienna, VA 22180-7021 |
Second Address | Arlington, VA 22207-2262 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 08/07/2007 |