Provider Demographics
NPI:1679705065
Name:KHOSHKBARIIE, AYDIN (DC)
Entity type:Individual
Prefix:DR
First Name:AYDIN
Middle Name:
Last Name:KHOSHKBARIIE
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 1:4608 NE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-5004
Mailing Address - Country:US
Mailing Address - Phone:425-226-6261
Mailing Address - Fax:425-917-5325
Practice Address - Street 1:4608 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-5004
Practice Address - Country:US
Practice Address - Phone:425-226-6261
Practice Address - Fax:425-917-5325
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60104381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor