Provider Demographics
NPI:1336721653
Name:KHAN, SHAHERYAR (DC)
Entity Type:Individual
Prefix:
First Name:SHAHERYAR
Middle Name:
Last Name:KHAN
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 1:3829 CIBOLA TRL
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-6239
Mailing Address - Country:US
Mailing Address - Phone:972-919-0035
Mailing Address - Fax:
Practice Address - Street 1:12817 PRESTON RD STE 136
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-7201
Practice Address - Country:US
Practice Address - Phone:469-442-6937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty