Provider Demographics
NPI:1093766636
Name:KHANALI, BAHRAM (DC)
Entity Type:Individual
Prefix:
First Name:BAHRAM
Middle Name:
Last Name:KHANALI
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 1:7504 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2719
Mailing Address - Country:US
Mailing Address - Phone:786-388-0273
Mailing Address - Fax:786-388-0273
Practice Address - Street 1:3090 SW 37TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4311
Practice Address - Country:US
Practice Address - Phone:305-351-1348
Practice Address - Fax:305-444-7866
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8546111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70000OtherBCBS OF FL
FLV06006Medicare UPIN
FL70000Medicare ID - Type UnspecifiedMEDICARE OF FL