Provider Demographics
NPI:1568495661
Name:MANKOOEI, SHAYDA (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAYDA
Middle Name:
Last Name:MANKOOEI
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 1:6800 BACKLICK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-3070
Mailing Address - Country:US
Mailing Address - Phone:703-644-5900
Mailing Address - Fax:703-644-5902
Practice Address - Street 1:6800 BACKLICK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-3070
Practice Address - Country:US
Practice Address - Phone:703-644-5900
Practice Address - Fax:703-644-5902
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor