Provider Demographics
NPI:1396748679
Name:SAMADIAN, MOHSEN (DC)
Entity type:Individual
Prefix:DR
First Name:MOHSEN
Middle Name:
Last Name:SAMADIAN
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 1:6430 RICHMOND AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-5918
Mailing Address - Country:US
Mailing Address - Phone:713-532-8575
Mailing Address - Fax:
Practice Address - Street 1:6430 RICHMOND AVE
Practice Address - Street 2:STE 220
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-5918
Practice Address - Country:US
Practice Address - Phone:713-532-8575
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT8859111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX606417OtherBLUE CROSS BLUE SHIELD
TX606417OtherBLUE CROSS BLUE SHIELD