Provider Demographics
NPI:1053571752
Name:NOORI, MOHAMAD BAKTASH (DC)
Entity type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:BAKTASH
Last Name:NOORI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MOHAMAD
Other - Middle Name:BAKTASH
Other - Last Name:NOORI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC DOCTOR OF CHIRO
Mailing Address - Street 1:21586 CABROSA STR
Mailing Address - Street 2:MISSION VEIJO
Mailing Address - City:MISSION VEIJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691
Mailing Address - Country:US
Mailing Address - Phone:949-813-6896
Mailing Address - Fax:949-582-5237
Practice Address - Street 1:21586 CABROSA
Practice Address - Street 2:MISSION VEIJO
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-1238
Practice Address - Country:US
Practice Address - Phone:949-813-6896
Practice Address - Fax:949-582-5237
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30885111NI0013X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111NN1001XChiropractic ProvidersChiropractorNutrition