Provider Demographics
NPI:1003231069
Name:AHMED, AHMED (CH60424734)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:CH60424734
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 230TH PL SW
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-5016
Mailing Address - Country:US
Mailing Address - Phone:404-694-9747
Mailing Address - Fax:
Practice Address - Street 1:3756 RAINIER AVE S
Practice Address - Street 2:SUITE D
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-6989
Practice Address - Country:US
Practice Address - Phone:206-725-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60424734111N00000X
GACHIR009114111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor