Provider Demographics
NPI:1780984450
Name:AZAD, AMIRREZA (DC)
Entity type:Individual
Prefix:DR
First Name:AMIRREZA
Middle Name:
Last Name:AZAD
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 1:2955 S GLEBE RD STE E
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-2730
Mailing Address - Country:US
Mailing Address - Phone:703-535-8887
Mailing Address - Fax:
Practice Address - Street 1:2955 S GLEBE RD STE E
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-2730
Practice Address - Country:US
Practice Address - Phone:703-535-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556844111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor