Provider Demographics
NPI:1063599348
Name:DERAKHSHANI, RAMBOD (DC)
Entity type:Individual
Prefix:DR
First Name:RAMBOD
Middle Name:
Last Name:DERAKHSHANI
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 1:3226 N MILLER RD STE 5
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6930
Mailing Address - Country:US
Mailing Address - Phone:480-214-4970
Mailing Address - Fax:480-214-4980
Practice Address - Street 1:3226 N MILLER RD STE 5
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6930
Practice Address - Country:US
Practice Address - Phone:480-214-4970
Practice Address - Fax:480-214-4980
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7385OtherAZ STATE CHIROPRACTIC LICENSE