Provider Demographics
NPI:1710573928
Name:MODAD, MASON ALLAN (DC)
Entity Type:Individual
Prefix:
First Name:MASON
Middle Name:ALLAN
Last Name:MODAD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1135 KELLER PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-1625
Mailing Address - Country:US
Mailing Address - Phone:817-337-3636
Mailing Address - Fax:817-337-3636
Practice Address - Street 1:1135 KELLER PKWY STE 200
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-1625
Practice Address - Country:US
Practice Address - Phone:817-337-3636
Practice Address - Fax:817-337-3636
Is Sole Proprietor?:No
Enumeration Date:2020-12-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX14576111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner