Healthcare Provider Details

I. General information

NPI: 1669635488
Provider Name (Legal Business Name): ADAM SIDI LEMNOUNI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 08/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 S OCEANSHORE BLVD
FLAGLER BEACH FL
32136-3703
US

IV. Provider business mailing address

1240 S OCEANSHORE BLVD
FLAGLER BEACH FL
32136-3703
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 NumberCH9565
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: