Provider Demographics
NPI:1134488257
Name:KHOSHBIN, ALI (DC)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:KHOSHBIN
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 1:15275 SW OBSIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8949
Mailing Address - Country:US
Mailing Address - Phone:503-232-4099
Mailing Address - Fax:503-234-0370
Practice Address - Street 1:2927 NE EVERETT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3248
Practice Address - Country:US
Practice Address - Phone:503-232-4099
Practice Address - Fax:503-234-0370
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4113111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor