Provider Demographics
NPI:1699981787
Name:NIKPOUR, REZA (DC)
Entity type:Individual
Prefix:
First Name:REZA
Middle Name:
Last Name:NIKPOUR
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 1:7891 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-5349
Mailing Address - Country:US
Mailing Address - Phone:703-658-0967
Mailing Address - Fax:703-658-0969
Practice Address - Street 1:7891 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-5349
Practice Address - Country:US
Practice Address - Phone:703-658-0967
Practice Address - Fax:703-658-0969
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor