Provider Demographics
NPI:1316475353
Name:PEZESHKI, SAMAN (DC)
Entity type:Individual
Prefix:DR
First Name:SAMAN
Middle Name:
Last Name:PEZESHKI
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 1:1798A MASSACHUSETTS AVE
Mailing Address - Street 2:STE 3B
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2809
Mailing Address - Country:US
Mailing Address - Phone:617-500-9116
Mailing Address - Fax:
Practice Address - Street 1:1798A MASSACHUSETTS AVE
Practice Address - Street 2:STE 3B
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-2809
Practice Address - Country:US
Practice Address - Phone:617-500-9116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNONE