Healthcare Provider Details

I. General information

NPI: 1902335417
Provider Name (Legal Business Name): NADIA FAKHOURY DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4027 JUDAH ST
SAN FRANCISCO CA
94122
US

IV. Provider business mailing address

306 24TH AVE
SAN FRANCISCO CA
94121
US

V. Phone/Fax

Practice location:
  • Phone: 415-319-2119
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number33820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: