Provider Demographics
NPI:1285093948
Name:HARATIZADEH, MEHRSA (DC)
Entity type:Individual
Prefix:
First Name:MEHRSA
Middle Name:
Last Name:HARATIZADEH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 W. MCDERMOTT DR.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3363
Mailing Address - Country:US
Mailing Address - Phone:972-954-1471
Mailing Address - Fax:214-495-0933
Practice Address - Street 1:3900 S. STONEBRIDGE DR.
Practice Address - Street 2:SUITE 801
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-8056
Practice Address - Country:US
Practice Address - Phone:972-427-1210
Practice Address - Fax:214-451-6063
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13064111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor