Provider Demographics
NPI:1417995150
Name:MOGHADDAM, MONIREH (DC)
Entity Type:Individual
Prefix:DR
First Name:MONIREH
Middle Name:
Last Name:MOGHADDAM
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 1:700 S FRIENDSWOOD DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-4581
Mailing Address - Country:US
Mailing Address - Phone:281-993-9100
Mailing Address - Fax:281-482-0750
Practice Address - Street 1:700 S FRIENDSWOOD DR
Practice Address - Street 2:SUITE E
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-4581
Practice Address - Country:US
Practice Address - Phone:281-993-9100
Practice Address - Fax:281-482-0750
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9236111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157280201Medicaid
TX157280201Medicaid