Provider Demographics
NPI:1972966588
Name:MOSADEGH, MOHAMMED
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:MOSADEGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:M
Other - Middle Name:Z
Other - Last Name:MOSADEGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1301 N COLLINS ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-5026
Mailing Address - Country:US
Mailing Address - Phone:817-274-9112
Mailing Address - Fax:817-274-9112
Practice Address - Street 1:1301 N COLLINS ST STE 201
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5026
Practice Address - Country:US
Practice Address - Phone:817-274-9112
Practice Address - Fax:817-274-9112
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10695111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation