Healthcare Provider Details

I. General information

NPI: 1972716132
Provider Name (Legal Business Name): VICTOR J. KHOURY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 N 19TH AVE SUITE E
PHOENIX AZ
85015-2903
US

IV. Provider business mailing address

5225 N 19TH AVE SUITE E
PHOENIX AZ
85015-2903
US

V. Phone/Fax

Practice location:
  • Phone: 602-274-8444
  • Fax: 602-274-8445
Mailing address:
  • Phone: 602-274-8444
  • Fax: 602-274-8445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5499
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: