Provider Demographics
NPI:1376213249
Name:PESSARAN BONAKDAR, SHIRIN (DC)
Entity Type:Individual
Prefix:DR
First Name:SHIRIN
Middle Name:
Last Name:PESSARAN BONAKDAR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 PRESTON RD STE 1250
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0603
Mailing Address - Country:US
Mailing Address - Phone:469-394-6776
Mailing Address - Fax:
Practice Address - Street 1:2809 PRESTON RD STE 1250
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-0603
Practice Address - Country:US
Practice Address - Phone:469-394-6776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor