Provider Demographics
NPI:1700114006
Name:KOLAILAT, MOHAMAD-ALI SAMIR (DC)
Entity Type:Individual
Prefix:DR
First Name:MOHAMAD-ALI
Middle Name:SAMIR
Last Name:KOLAILAT
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 1:1818 E BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-6106
Mailing Address - Country:US
Mailing Address - Phone:972-203-7625
Mailing Address - Fax:
Practice Address - Street 1:1818 E BELT LINE RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-6106
Practice Address - Country:US
Practice Address - Phone:972-203-7625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11649111N00000X
GACHIR008533111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor