Provider Demographics
NPI:1689186843
Name:KHAJAVEI, NICHOLI HOSSEIN (DC)
Entity type:Individual
Prefix:
First Name:NICHOLI
Middle Name:HOSSEIN
Last Name:KHAJAVEI
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 1:18500 SE 17TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9723
Mailing Address - Country:US
Mailing Address - Phone:503-490-8538
Mailing Address - Fax:
Practice Address - Street 1:18500 SE 17TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9723
Practice Address - Country:US
Practice Address - Phone:503-490-8538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor