Provider Demographics
NPI:1780816876
Name:HOSSEIN, MANSOUR (DC)
Entity Type:Individual
Prefix:DR
First Name:MANSOUR
Middle Name:
Last Name:HOSSEIN
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 1:2155 NW 173RD AVE
Mailing Address - Street 2:SUITE# 103
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006
Mailing Address - Country:US
Mailing Address - Phone:503-352-0735
Mailing Address - Fax:503-352-0734
Practice Address - Street 1:2155 NW 173RD AVE
Practice Address - Street 2:SUITE# 103
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006
Practice Address - Country:US
Practice Address - Phone:503-352-0735
Practice Address - Fax:503-352-0734
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor