Provider Demographics
NPI:1265483507
Name:TABARESTANI, TONY K (DC)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:K
Last Name:TABARESTANI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:14770 MEMORIAL DR STE 220
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-5252
Mailing Address - Country:US
Mailing Address - Phone:281-493-5535
Mailing Address - Fax:281-493-3353
Practice Address - Street 1:6535 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2207
Practice Address - Country:US
Practice Address - Phone:713-981-8184
Practice Address - Fax:713-981-8114
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4143111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81V735OtherBUE CROSS BLUE SHIELD OF
TX769339OtherCOVENTRY & FIRST HEALTH