Provider Demographics
NPI:1740864867
Name:GHANBARI, GOLZAR NIKA (DC)
Entity type:Individual
Prefix:
First Name:GOLZAR
Middle Name:NIKA
Last Name:GHANBARI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 N GREAT NECK RD # 1272-182
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2268
Mailing Address - Country:US
Mailing Address - Phone:757-364-0067
Mailing Address - Fax:757-416-7777
Practice Address - Street 1:2830 VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7614
Practice Address - Country:US
Practice Address - Phone:757-364-0067
Practice Address - Fax:757-416-7777
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557733111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor