Provider Demographics
NPI:1598759565
Name:ALYESHMERNI, OMID (DC)
Entity type:Individual
Prefix:DR
First Name:OMID
Middle Name:
Last Name:ALYESHMERNI
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 1:7333 W THOMAS RD
Mailing Address - Street 2:#40
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-5546
Mailing Address - Country:US
Mailing Address - Phone:623-849-1736
Mailing Address - Fax:623-849-0406
Practice Address - Street 1:7333 W THOMAS RD
Practice Address - Street 2:#40
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-5546
Practice Address - Country:US
Practice Address - Phone:623-849-1736
Practice Address - Fax:623-849-0406
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4991111N00000X
NYX010908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0245210OtherBC/BS AZ
AZ0245210OtherBC/BS AZ
U40080Medicare UPIN