Provider Demographics
NPI:1487735023
Name:KHAJEHAFZALY, RAMIN (DC)
Entity type:Individual
Prefix:
First Name:RAMIN
Middle Name:
Last Name:KHAJEHAFZALY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:RAMIN
Other - Middle Name:
Other - Last Name:AFZALY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:6601 LITTLE RIVER TPKE
Mailing Address - Street 2:# 310
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1303
Mailing Address - Country:US
Mailing Address - Phone:703-941-4464
Mailing Address - Fax:703-941-4647
Practice Address - Street 1:6601 LITTLE RIVER TPKE
Practice Address - Street 2:# 310
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-1303
Practice Address - Country:US
Practice Address - Phone:703-941-4464
Practice Address - Fax:703-941-4647
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001774111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA609388Medicare UPIN
VAF9540001Medicare UPIN
VA321390Medicare UPIN
VA256789Medicare UPIN