Provider Demographics
NPI:1861452625
Name:FERDOWSIAN, OMID (DC, CCEP)
Entity Type:Individual
Prefix:DR
First Name:OMID
Middle Name:
Last Name:FERDOWSIAN
Suffix:
Gender:M
Credentials:DC, CCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 LOGAN ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3130
Mailing Address - Country:US
Mailing Address - Phone:303-831-1122
Mailing Address - Fax:303-831-1144
Practice Address - Street 1:899 N LOGAN ST
Practice Address - Street 2:STE 105
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3154
Practice Address - Country:US
Practice Address - Phone:303-831-1122
Practice Address - Fax:303-831-1144
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5466111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO668207OtherBC/BS PROVIDER #
COU97935Medicare UPIN
CO518008Medicare ID - Type Unspecified