Provider Demographics
NPI:1083857825
Name:MAHMOOD AMELI LLC
Entity Type:Organization
Organization Name:MAHMOOD AMELI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOOD
Authorized Official - Middle Name:
Authorized Official - Last Name:AMELI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-895-5903
Mailing Address - Street 1:3404 E BURNSVILLE PKWY
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-3488
Mailing Address - Country:US
Mailing Address - Phone:952-898-5903
Mailing Address - Fax:
Practice Address - Street 1:10880 175TH CT W
Practice Address - Street 2:SUITE 120
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-8781
Practice Address - Country:US
Practice Address - Phone:952-898-4900
Practice Address - Fax:952-898-7626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1237111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty