Provider Demographics
NPI:1689048779
Name:HOSSEINI, HESSAM SAM (DC)
Entity Type:Individual
Prefix:DR
First Name:HESSAM
Middle Name:SAM
Last Name:HOSSEINI
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 1:901 N JUPITER RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-3244
Mailing Address - Country:US
Mailing Address - Phone:469-330-2225
Mailing Address - Fax:
Practice Address - Street 1:901 N JUPITER RD
Practice Address - Street 2:SUITE 110
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-3244
Practice Address - Country:US
Practice Address - Phone:469-330-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor