Provider Demographics
NPI:1669612024
Name:ALIZADEH, KAHVEH JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:KAHVEH
Middle Name:JOHN
Last Name:ALIZADEH
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 1:734 TERRA VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-9318
Mailing Address - Country:US
Mailing Address - Phone:970-402-5639
Mailing Address - Fax:
Practice Address - Street 1:734 TERRA VIEW CIR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-9318
Practice Address - Country:US
Practice Address - Phone:970-402-5639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011356111N00000X
WY723111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor