Provider Demographics
NPI:1720212103
Name:MANKOOEI CHIROPRACTIC CENTER 2, LLC
Entity Type:Organization
Organization Name:MANKOOEI CHIROPRACTIC CENTER 2, LLC
Other - Org Name:COMMERCE CHIROPRACTIC CENTER 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAYDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANKOOEI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-730-0707
Mailing Address - Street 1:4328 DALE BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-2402
Mailing Address - Country:US
Mailing Address - Phone:703-730-0707
Mailing Address - Fax:703-730-0770
Practice Address - Street 1:4328 DALE BLVD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-2402
Practice Address - Country:US
Practice Address - Phone:703-730-0707
Practice Address - Fax:703-730-0770
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANKOOEI CHIROPRACTIC CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555961261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center