Provider Demographics
NPI:1770649568
Name:SAFAEIAN, ANTHONY PEZHMAN (DC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:PEZHMAN
Last Name:SAFAEIAN
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 1:12811 8TH AVE W STE B103
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-6369
Mailing Address - Country:US
Mailing Address - Phone:425-513-6959
Mailing Address - Fax:425-513-0230
Practice Address - Street 1:12811 8TH AVE W STE B103
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-6369
Practice Address - Country:US
Practice Address - Phone:425-513-6959
Practice Address - Fax:425-513-0230
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034128111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2026383Medicaid
WA0161524OtherL&I
WAGAB29807Medicare ID - Type Unspecified
WA0161524OtherL&I