Provider Demographics
NPI:1598843542
Name:KHORRAMI, AHMAD ZIA (DC)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:ZIA
Last Name:KHORRAMI
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 1:222 N MILL ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MI
Mailing Address - Zip Code:48880-1523
Mailing Address - Country:US
Mailing Address - Phone:989-681-4107
Mailing Address - Fax:989-681-3628
Practice Address - Street 1:222 N MILL ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MI
Practice Address - Zip Code:48880-1523
Practice Address - Country:US
Practice Address - Phone:989-681-4107
Practice Address - Fax:989-681-3628
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4967141Medicaid
MI00882OtherRAILROAD MEDICARE
MI1598843542OtherNPI NUMBER
MI1598843542OtherNPI NUMBER
MI0P11000Medicare ID - Type UnspecifiedCHIROPRACTIC CARE