Provider Demographics
NPI:1043524770
Name:MOGHADAM, SARA (DC)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:MOGHADAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8141 DURHAM DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-7352
Mailing Address - Country:US
Mailing Address - Phone:469-231-6784
Mailing Address - Fax:
Practice Address - Street 1:3307 BELT LINE RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-6913
Practice Address - Country:US
Practice Address - Phone:972-496-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor