Provider Demographics
NPI:1710341789
Name:KARIMABADI, MARYAM (DC)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:KARIMABADI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 OLD RANCH RD
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-4201
Mailing Address - Country:US
Mailing Address - Phone:415-261-0408
Mailing Address - Fax:
Practice Address - Street 1:25 OLD RANCH RD
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-4201
Practice Address - Country:US
Practice Address - Phone:415-261-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15549111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation