Provider Demographics
NPI:1760929350
Name:ASHTIANI, SHABNAM (DC, MS)
Entity Type:Individual
Prefix:DR
First Name:SHABNAM
Middle Name:
Last Name:ASHTIANI
Suffix:
Gender:F
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 N LOOP 1604 E STE 1202
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1370
Mailing Address - Country:US
Mailing Address - Phone:210-926-5766
Mailing Address - Fax:210-926-5767
Practice Address - Street 1:1270 N LOOP 1604 E STE 1202
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1370
Practice Address - Country:US
Practice Address - Phone:210-926-5766
Practice Address - Fax:210-926-5767
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor