Provider Demographics
NPI:1225451230
Name:HEIDARI, MOHAMMAD ALEXANDER (DC)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:ALEXANDER
Last Name:HEIDARI
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 1:3334 N. TOWN EAST BLVD.
Mailing Address - Street 2:#102
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150
Mailing Address - Country:US
Mailing Address - Phone:972-681-8321
Mailing Address - Fax:972-613-8927
Practice Address - Street 1:3334 N. TOWN EAST BLVD.
Practice Address - Street 2:#102
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150
Practice Address - Country:US
Practice Address - Phone:972-681-8321
Practice Address - Fax:972-613-8927
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor