Provider Demographics
NPI:1740366715
Name:SHIRAZI, MIR S (DC)
Entity type:Individual
Prefix:DR
First Name:MIR
Middle Name:S
Last Name:SHIRAZI
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 1:52 HAROLD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1026
Mailing Address - Country:US
Mailing Address - Phone:408-241-6161
Mailing Address - Fax:408-241-6262
Practice Address - Street 1:52 HAROLD AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1026
Practice Address - Country:US
Practice Address - Phone:408-241-6161
Practice Address - Fax:408-241-6262
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29004111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0290040Medicare ID - Type Unspecified
CAV04841Medicare UPIN