Healthcare Provider Details

I. General information

NPI: 1235420340
Provider Name (Legal Business Name): AQUA CHIROPRACTIC & DAY SPA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2011
Last Update Date: 04/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3970 W 24TH ST SUITE 104
YUMA AZ
85364-9255
US

IV. Provider business mailing address

3970 W 24TH ST SUITE 104
YUMA AZ
85364-9255
US

V. Phone/Fax

Practice location:
  • Phone: 928-782-1818
  • Fax: 888-899-2073
Mailing address:
  • Phone: 928-782-1818
  • Fax: 888-899-2073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8168
License Number StateAZ

VIII. Authorized Official

Name: DR. ZEYAD DANNY ABOUL-HOSN
Title or Position: OWNER
Credential: D.C.
Phone: 949-887-1327