Provider Demographics
NPI:1619508157
Name:POURIAN, SAM (DC)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:POURIAN
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:PO BOX 903
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85252-0903
Mailing Address - Country:US
Mailing Address - Phone:480-203-9649
Mailing Address - Fax:
Practice Address - Street 1:1059 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-2153
Practice Address - Country:US
Practice Address - Phone:480-833-8003
Practice Address - Fax:480-962-6384
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty