Provider Demographics
NPI:1699270173
Name:MY CHIROPRACTIC DOCTOR
Entity type:Organization
Organization Name:MY CHIROPRACTIC DOCTOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARANAK
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHERI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-663-8808
Mailing Address - Street 1:8133 LEESBURG PIKE STE 100
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2706
Mailing Address - Country:US
Mailing Address - Phone:703-663-8088
Mailing Address - Fax:
Practice Address - Street 1:8133 LEESBURG PIKE STE 100
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2706
Practice Address - Country:US
Practice Address - Phone:703-663-8088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-27
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty