Provider Demographics
NPI:1831131374
Name:QAADRI, MOTAHAR (DC)
Entity Type:Individual
Prefix:DR
First Name:MOTAHAR
Middle Name:
Last Name:QAADRI
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 1:11030 LOST STONE DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-0076
Mailing Address - Country:US
Mailing Address - Phone:215-630-8712
Mailing Address - Fax:
Practice Address - Street 1:500 MEDICAL CENTER BLVD STE 220
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2800
Practice Address - Country:US
Practice Address - Phone:832-403-3116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008839111N00000X
TX13665111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA074354Medicare ID - Type Unspecified