Provider Demographics
NPI:1780795757
Name:KAMYAB, ALI A (DC)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:A
Last Name:KAMYAB
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 1:2500 WALNUT HILL LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-5609
Mailing Address - Country:US
Mailing Address - Phone:972-438-6932
Mailing Address - Fax:214-902-3475
Practice Address - Street 1:111 S DELAWARE ST
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-3031
Practice Address - Country:US
Practice Address - Phone:972-438-6932
Practice Address - Fax:214-902-3475
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6447111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB102714Medicare Oscar/Certification