Provider Demographics
NPI:1780264630
Name:KHANBABAZADEH, MAHDI (DC)
Entity type:Individual
Prefix:DR
First Name:MAHDI
Middle Name:
Last Name:KHANBABAZADEH
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 1:20001 SW TUALATIN VALLEY HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-2300
Mailing Address - Country:US
Mailing Address - Phone:971-570-7860
Mailing Address - Fax:833-222-8117
Practice Address - Street 1:20001 SW TUALATIN VALLEY HWY STE 102
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97003-2300
Practice Address - Country:US
Practice Address - Phone:971-570-7860
Practice Address - Fax:833-222-8117
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6145111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor