Provider Demographics
NPI:1437365301
Name:VASSIGH, GOUDARZ (DC)
Entity Type:Individual
Prefix:DR
First Name:GOUDARZ
Middle Name:
Last Name:VASSIGH
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 1:4425 N 24TH ST
Mailing Address - Street 2:STE 125
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5596
Mailing Address - Country:US
Mailing Address - Phone:602-956-8222
Mailing Address - Fax:602-956-8333
Practice Address - Street 1:4425 N 24TH ST
Practice Address - Street 2:STE 125
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5596
Practice Address - Country:US
Practice Address - Phone:602-956-8222
Practice Address - Fax:602-956-8333
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5608111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ28235Medicare ID - Type Unspecified