Provider Demographics
NPI:1407073661
Name:GHAZVINI, MEHRAN PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:MEHRAN
Middle Name:PETER
Last Name:GHAZVINI
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 1:2811 INDUSTRIAL PLAZA DR STE C
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-3583
Mailing Address - Country:US
Mailing Address - Phone:850-942-6600
Mailing Address - Fax:850-942-6620
Practice Address - Street 1:2811 INDUSTRIAL PLAZA DR STE C
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-3583
Practice Address - Country:US
Practice Address - Phone:850-942-6600
Practice Address - Fax:850-942-6620
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7262111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55521Medicare ID - Type Unspecified