Provider Demographics
NPI:1699939157
Name:AWAD, MOHAMMAD A (DC)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:A
Last Name:AWAD
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 1:201 W GUADALUPE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3327
Mailing Address - Country:US
Mailing Address - Phone:480-782-7705
Mailing Address - Fax:480-813-4728
Practice Address - Street 1:201 W GUADALUPE RD STE 201
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3327
Practice Address - Country:US
Practice Address - Phone:480-782-7705
Practice Address - Fax:480-813-4728
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7880111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor