Healthcare Provider Details

I. General information

NPI: 1073519864
Provider Name (Legal Business Name): FLAGLER CHIROPRACTIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 SOUTH AIA
FLAGLER BEACH FL
32136
US

IV. Provider business mailing address

1240 SOUTH AIA
FLAGLER BEACH FL
32136
US

V. Phone/Fax

Practice location:
  • Phone: 386-439-9001
  • Fax: 386-439-9002
Mailing address:
  • Phone: 386-439-9001
  • Fax: 386-439-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateFL

VIII. Authorized Official

Name: SIDI M LEMNOUNI
Title or Position: CHIROPRACTIC PHYSICIAN
Credential: DC
Phone: 386-439-9001