Provider Demographics
NPI:1376748350
Name:SHAHRAM JAMALABADI
Entity Type:Organization
Organization Name:SHAHRAM JAMALABADI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:SHAHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMALABADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-455-6600
Mailing Address - Street 1:2911 TERRELL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-5567
Mailing Address - Country:US
Mailing Address - Phone:903-455-6600
Mailing Address - Fax:
Practice Address - Street 1:2911 TERRELL RD
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-5567
Practice Address - Country:US
Practice Address - Phone:903-455-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10270111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X720Medicare PIN