Provider Demographics
NPI:1205270014
Name:MOHAMMADI, FARID M (DC)
Entity type:Individual
Prefix:DR
First Name:FARID
Middle Name:M
Last Name:MOHAMMADI
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 1:10387 MAIN ST
Mailing Address - Street 2:SUITE LL2
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2453
Mailing Address - Country:US
Mailing Address - Phone:571-344-3744
Mailing Address - Fax:703-591-3725
Practice Address - Street 1:10387 MAIN ST
Practice Address - Street 2:SUITE LL2
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2453
Practice Address - Country:US
Practice Address - Phone:571-344-3744
Practice Address - Fax:703-591-3725
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557077111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor