Provider Demographics
NPI:1134343304
Name:BEIRAGHDAR, MAHIN BANOU (DC)
Entity type:Individual
Prefix:DR
First Name:MAHIN
Middle Name:BANOU
Last Name:BEIRAGHDAR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MAHIN
Other - Middle Name:B
Other - Last Name:BANOU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 5824
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-1424
Mailing Address - Country:US
Mailing Address - Phone:202-265-6000
Mailing Address - Fax:202-265-6018
Practice Address - Street 1:4123 CONNECTICUT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-1155
Practice Address - Country:US
Practice Address - Phone:202-265-6000
Practice Address - Fax:202-265-6018
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCH19644111N00000X
SC924111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor