Provider Demographics
NPI:1962854711
Name:NEKOOMAND, AMIN (DC)
Entity Type:Individual
Prefix:DR
First Name:AMIN
Middle Name:
Last Name:NEKOOMAND
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 1:595 COUNTRY LN STE 2
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-9599
Mailing Address - Country:US
Mailing Address - Phone:319-853-0000
Mailing Address - Fax:319-853-0000
Practice Address - Street 1:595 COUNTRY LN STE 2
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-9599
Practice Address - Country:US
Practice Address - Phone:319-853-0000
Practice Address - Fax:319-853-0000
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082789111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1962854711OtherNPI