Provider Demographics
NPI:1386304137
Name:REZA CHIROPRACTIC AND MDT, P.C.
Entity type:Organization
Organization Name:REZA CHIROPRACTIC AND MDT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHASSEMI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-920-1807
Mailing Address - Street 1:85 MILL TOWN LOOP UNIT E
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-5139
Mailing Address - Country:US
Mailing Address - Phone:406-920-1807
Mailing Address - Fax:
Practice Address - Street 1:85 MILL TOWN LOOP UNIT E
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-5139
Practice Address - Country:US
Practice Address - Phone:406-920-1807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty