Provider Demographics
NPI:1578697728
Name:KHAKPOUR, MOHAMMAD (DC)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:KHAKPOUR
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 1:13410 PRESTON RD
Mailing Address - Street 2:STE 1-129
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-5299
Mailing Address - Country:US
Mailing Address - Phone:972-503-6325
Mailing Address - Fax:972-503-1954
Practice Address - Street 1:13021 COIT RD
Practice Address - Street 2:STE106
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5789
Practice Address - Country:US
Practice Address - Phone:972-503-6325
Practice Address - Fax:972-503-1954
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7991111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC06092127Medicaid
TX605946OtherBCBS
TX605946OtherBCBS
TXU73963Medicare UPIN