Healthcare Provider Details

I. General information

NPI: 1093129637
Provider Name (Legal Business Name): DAOUD'S PROKINETIC SPORTS CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73140 HIGHWAY 111 STE 8
PALM DESERT CA
92260-3927
US

IV. Provider business mailing address

73140 HIGHWAY 111
PALM DESERT CA
92260-3927
US

V. Phone/Fax

Practice location:
  • Phone: 760-834-8725
  • Fax: 760-834-8725
Mailing address:
  • Phone: 760-834-8725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number33093
License Number StateCA

VIII. Authorized Official

Name: DR. MAURICE DAOUD
Title or Position: MANAGER
Credential: DC
Phone: 760-834-8725