Provider Demographics
NPI:1689789000
Name:MAKOOI, MAHMOOD MOAYED (DC, CCSP)
Entity Type:Individual
Prefix:
First Name:MAHMOOD
Middle Name:MOAYED
Last Name:MAKOOI
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 REDWOOD ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-3603
Mailing Address - Country:US
Mailing Address - Phone:707-644-8480
Mailing Address - Fax:707-644-3926
Practice Address - Street 1:2121 REDWOOD ST
Practice Address - Street 2:SUITE G
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-3603
Practice Address - Country:US
Practice Address - Phone:707-644-8480
Practice Address - Fax:707-644-3926
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21746111N00000X
CA3115111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0217460Medicare ID - Type Unspecified