Provider Demographics
NPI:1386652352
Name:GHASSEMITARI, MARJANEH (DC)
Entity Type:Individual
Prefix:MRS
First Name:MARJANEH
Middle Name:
Last Name:GHASSEMITARI
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:P.O. BOX 868058
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75086-8058
Mailing Address - Country:US
Mailing Address - Phone:214-738-2170
Mailing Address - Fax:817-963-8896
Practice Address - Street 1:2600 K AVE #136
Practice Address - Street 2:136
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5306
Practice Address - Country:US
Practice Address - Phone:214-738-2170
Practice Address - Fax:817-963-8896
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8505111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH060813101OtherBLUE CROSS BLUE SHIELD
TXH060813101OtherBLUE CROSS BLUE SHIELD