Provider Demographics
NPI:1821040775
Name:RAHIMINEJAD, RADMAN (DC)
Entity Type:Individual
Prefix:
First Name:RADMAN
Middle Name:
Last Name:RAHIMINEJAD
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 1:2390 E ELGIN ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2311
Mailing Address - Country:US
Mailing Address - Phone:602-909-6526
Mailing Address - Fax:
Practice Address - Street 1:1949 W RAY RD
Practice Address - Street 2:STE 14
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4003
Practice Address - Country:US
Practice Address - Phone:480-917-1720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7150111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0941220OtherBCBS PROVIDER ID
AZ84062Medicare PIN
AZ86992Medicare UPIN