Provider Demographics
NPI:1255566691
Name:TABRIZI, MAHMOOD T (DC)
Entity type:Individual
Prefix:DR
First Name:MAHMOOD
Middle Name:T
Last Name:TABRIZI
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 1:4310 GARTH RD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3114
Mailing Address - Country:US
Mailing Address - Phone:281-428-2436
Mailing Address - Fax:281-422-9910
Practice Address - Street 1:4310 GARTH RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3114
Practice Address - Country:US
Practice Address - Phone:281-428-2436
Practice Address - Fax:281-422-9910
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX603143Medicare PIN