Provider Demographics
NPI:1912918681
Name:AHMADIYAR, AMIR H (DC)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:H
Last Name:AHMADIYAR
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 1:6521 ARLINGTON BLVD., SUITE 100
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042
Mailing Address - Country:US
Mailing Address - Phone:703-538-5455
Mailing Address - Fax:703-538-6675
Practice Address - Street 1:6521 ARLINGTON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3017
Practice Address - Country:US
Practice Address - Phone:703-538-5455
Practice Address - Fax:703-538-6675
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001051111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9516557Medicaid
VAU50396Medicare UPIN
VA9516557Medicaid