Provider Demographics
NPI:1083096861
Name:BAKHTAR, JOUBIN (DC)
Entity Type:Individual
Prefix:
First Name:JOUBIN
Middle Name:
Last Name:BAKHTAR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 OLD CHAIN BRIDGE RD.
Mailing Address - Street 2:SUITE 300A
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3955
Mailing Address - Country:US
Mailing Address - Phone:703-662-0220
Mailing Address - Fax:571-814-3268
Practice Address - Street 1:1340 OLD CHAIN BRIDGE RD.
Practice Address - Street 2:SUITE 300A
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3955
Practice Address - Country:US
Practice Address - Phone:703-662-0220
Practice Address - Fax:571-814-3268
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1083096861OtherNPI
VA812277169OtherEIN