Provider Demographics
NPI:1124037577
Name:AZARTASH-NAMIN, HOSSEIN (DC)
Entity Type:Individual
Prefix:DR
First Name:HOSSEIN
Middle Name:
Last Name:AZARTASH-NAMIN
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 1:2905 S HARR DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3040
Mailing Address - Country:US
Mailing Address - Phone:405-455-2368
Mailing Address - Fax:405-455-2368
Practice Address - Street 1:2905 S HARR DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3040
Practice Address - Country:US
Practice Address - Phone:405-455-2368
Practice Address - Fax:405-455-2368
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor