Provider Demographics
NPI:1750160917
Name:KOLAHDOUZAN, MOSTAFA (DC)
Entity type:Individual
Prefix:
First Name:MOSTAFA
Middle Name:
Last Name:KOLAHDOUZAN
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1886 METRO CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5289
Mailing Address - Country:US
Mailing Address - Phone:540-409-1887
Mailing Address - Fax:
Practice Address - Street 1:1886 METRO CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5289
Practice Address - Country:US
Practice Address - Phone:540-409-1887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557934111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor