Provider Demographics
NPI:1255618120
Name:DAVARI, MEHRTASH (DC)
Entity type:Individual
Prefix:DR
First Name:MEHRTASH
Middle Name:
Last Name:DAVARI
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 1:8430 W. BROWARD BLVD., STE. 250
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324
Mailing Address - Country:US
Mailing Address - Phone:954-772-9052
Mailing Address - Fax:954-628-5109
Practice Address - Street 1:8430 W. BROWARD BLVD., STE. 250
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324
Practice Address - Country:US
Practice Address - Phone:954-772-9052
Practice Address - Fax:954-628-5109
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10443111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor