Provider Demographics
NPI:1881016798
Name:DR. REZA GHASSEMI, D.C., P.A.
Entity Type:Organization
Organization Name:DR. REZA GHASSEMI, D.C., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHASSEMI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-519-7443
Mailing Address - Street 1:5625 4TH ST N
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-2260
Mailing Address - Country:US
Mailing Address - Phone:727-519-7443
Mailing Address - Fax:
Practice Address - Street 1:5625 4TH ST N
Practice Address - Street 2:SUITE 2B
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-2260
Practice Address - Country:US
Practice Address - Phone:727-519-7443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-11
Last Update Date:2014-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9274111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002090200Medicaid
FLCX788ZMedicare PIN