Provider Demographics
NPI:1659419521
Name:MOOSSAVI, MEHDI (MA, DC)
Entity Type:Individual
Prefix:DR
First Name:MEHDI
Middle Name:
Last Name:MOOSSAVI
Suffix:
Gender:M
Credentials:MA, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 MERIDIAN AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2905
Mailing Address - Country:US
Mailing Address - Phone:408-288-8999
Mailing Address - Fax:408-288-8922
Practice Address - Street 1:259 MERIDIAN AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2905
Practice Address - Country:US
Practice Address - Phone:408-288-8999
Practice Address - Fax:408-288-8922
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22781111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor