Provider Demographics
NPI:1114148053
Name:KHAN, MANSOOR (DC)
Entity Type:Individual
Prefix:DR
First Name:MANSOOR
Middle Name:
Last Name:KHAN
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 1:5202 TEXANA DR APT 1438
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3903
Mailing Address - Country:US
Mailing Address - Phone:210-921-0265
Mailing Address - Fax:210-922-9679
Practice Address - Street 1:4402 VANCE JACKSON RD STE 112
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5333
Practice Address - Country:US
Practice Address - Phone:210-921-0265
Practice Address - Fax:210-922-9679
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC 9079111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor