Provider Demographics
NPI:1942404231
Name:JAFARIEH, MARYAM (DC)
Entity Type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:
Last Name:JAFARIEH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5165 NW 11TH LN
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-8621
Mailing Address - Country:US
Mailing Address - Phone:954-554-4662
Mailing Address - Fax:954-229-1996
Practice Address - Street 1:1919 NE 45TH ST STE 219
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5136
Practice Address - Country:US
Practice Address - Phone:954-229-1995
Practice Address - Fax:954-667-7954
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8598111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12146914OtherCAQH