Provider Demographics
NPI:1144040874
Name:HARATI, PARHAM (DC, MS)
Entity type:Individual
Prefix:DR
First Name:PARHAM
Middle Name:
Last Name:HARATI
Suffix:
Gender:M
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 NE 73RD AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-6054
Mailing Address - Country:US
Mailing Address - Phone:971-406-9095
Mailing Address - Fax:
Practice Address - Street 1:10355 NW GLENCOE RD STE B
Practice Address - Street 2:
Practice Address - City:NORTH PLAINS
Practice Address - State:OR
Practice Address - Zip Code:97133-8244
Practice Address - Country:US
Practice Address - Phone:971-254-9988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61610862111N00000X
OR6418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor