Provider Demographics
NPI:1790724722
Name:AMELI, DARIAN MAHMOOD (DC)
Entity Type:Individual
Prefix:DR
First Name:DARIAN
Middle Name:MAHMOOD
Last Name:AMELI
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 1:5710 S 53RD ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3276
Mailing Address - Country:US
Mailing Address - Phone:402-770-5967
Mailing Address - Fax:402-904-4223
Practice Address - Street 1:5710 S 53RD ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-3276
Practice Address - Country:US
Practice Address - Phone:402-770-5967
Practice Address - Fax:402-904-4223
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3187111N00000X
NE1451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4487765OtherMEDICA PROVIDER NUMBER
MN974019800Medicaid
MN350003253Medicare ID - Type UnspecifiedMEDICARE