Provider Demographics
NPI:1477645778
Name:JAMALABADI, SHAHRAM (DC)
Entity Type:Individual
Prefix:
First Name:SHAHRAM
Middle Name:
Last Name:JAMALABADI
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 1:2911 TERRELL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402
Mailing Address - Country:US
Mailing Address - Phone:903-455-6600
Mailing Address - Fax:903-455-4456
Practice Address - Street 1:2911 TERRELL RD
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-5567
Practice Address - Country:US
Practice Address - Phone:903-455-6600
Practice Address - Fax:903-455-4456
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10270111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX608282OtherBLUE CROSS BLUE SHIELD
TX1477645778OtherBLUECROSS/BLUE SHIELD
TX1477645778OtherBLUECROSS/BLUE SHIELD
TX608282OtherBLUE CROSS BLUE SHIELD