Provider Demographics
NPI:1467520783
Name:KHANI, MOSEN RASHID (DC)
Entity Type:Individual
Prefix:DR
First Name:MOSEN
Middle Name:RASHID
Last Name:KHANI
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 1:10701 W. MANSLICK RD.
Mailing Address - Street 2:
Mailing Address - City:FAIRDALE
Mailing Address - State:KY
Mailing Address - Zip Code:40118
Mailing Address - Country:US
Mailing Address - Phone:502-367-2112
Mailing Address - Fax:502-367-7799
Practice Address - Street 1:10701 W. MANSLICK RD.
Practice Address - Street 2:
Practice Address - City:FAIRDALE
Practice Address - State:KY
Practice Address - Zip Code:40118
Practice Address - Country:US
Practice Address - Phone:502-367-2112
Practice Address - Fax:502-367-7799
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4056111N00000X
CA20358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85001568Medicaid
KY1150524OtherPASSPORT MEDICAID
KY000000108879OtherANTHEM
KY1150524OtherPASSPORT MEDICAID