Provider Demographics
NPI:1114143773
Name:AMIR AHMADIYAR DC PC
Entity Type:Organization
Organization Name:AMIR AHMADIYAR DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:H
Authorized Official - Last Name:AHMADIYAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-538-5455
Mailing Address - Street 1:6521 ARLINGTON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-3017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6521 ARLINGTON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3017
Practice Address - Country:US
Practice Address - Phone:703-538-5455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9516557Medicaid
VA00B774A76Medicare ID - Type Unspecified
VA9516557Medicaid