Provider Demographics
NPI:1982602967
Name:KHAZNEHKATBI, CAROL ELIZABETH (BS, DC)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ELIZABETH
Last Name:KHAZNEHKATBI
Suffix:
Gender:F
Credentials:BS, DC
Other - Prefix:DR
Other - First Name:CAROL
Other - Middle Name:E
Other - Last Name:DUBBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:122 NEW ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-5623
Mailing Address - Country:US
Mailing Address - Phone:586-468-5381
Mailing Address - Fax:
Practice Address - Street 1:122 NEW ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-5623
Practice Address - Country:US
Practice Address - Phone:586-468-5381
Practice Address - Fax:586-468-9915
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI8891111N00000X
MI2301008891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E016390OtherBLUE CROSS BLUE SHIELD
MI0P08870Medicare ID - Type Unspecified