Provider Demographics
NPI:1730131533
Name:DONESH, REZA (DC)
Entity type:Individual
Prefix:
First Name:REZA
Middle Name:
Last Name:DONESH
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:PO BOX 55954
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77255-5954
Mailing Address - Country:US
Mailing Address - Phone:713-465-2542
Mailing Address - Fax:713-465-5018
Practice Address - Street 1:8561 LONGPIONT DR
Practice Address - Street 2:103
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055
Practice Address - Country:US
Practice Address - Phone:713-465-2422
Practice Address - Fax:713-465-5018
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC 6538111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605103Medicare ID - Type Unspecified