Provider Demographics
NPI:1255723979
Name:PHOENIXINJURYCENTERINC
Entity type:Organization
Organization Name:PHOENIXINJURYCENTERINC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GHODRATT
Authorized Official - Middle Name:
Authorized Official - Last Name:BORAZJANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:832-498-3000
Mailing Address - Street 1:6420 RICHMOND AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-5921
Mailing Address - Country:US
Mailing Address - Phone:832-242-6402
Mailing Address - Fax:832-242-6564
Practice Address - Street 1:6420 RICHMOND AVE STE 250
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-5921
Practice Address - Country:US
Practice Address - Phone:832-242-6402
Practice Address - Fax:832-242-6564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty