Healthcare Provider Details

I. General information

NPI: 1144458480
Provider Name (Legal Business Name): FAKHOURY MEDICAL & CHIROPRACTIC CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 SW 17TH ST
OCALA FL
34471-1229
US

IV. Provider business mailing address

1009 SW 17TH ST
OCALA FL
34471-1229
US

V. Phone/Fax

Practice location:
  • Phone: 352-351-3413
  • Fax: 352-629-6667
Mailing address:
  • Phone: 352-351-3413
  • Fax: 352-629-6667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8727
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2307
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME95990
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH10017
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH9421
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberME49250
License Number StateFL
# 7
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH4912
License Number StateFL

VIII. Authorized Official

Name: DR. RIADH A FAKHOURY
Title or Position: OWNER
Credential:
Phone: 352-351-3413