Healthcare Provider Details

I. General information

NPI: 1255439949
Provider Name (Legal Business Name): JAMAL A FAKHOURY D.C., F.A.C.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 SE 37TH ST
OCALA FL
34480-9037
US

IV. Provider business mailing address

4710 SE 37TH ST
OCALA FL
34480-9037
US

V. Phone/Fax

Practice location:
  • Phone: 352-266-6199
  • Fax:
Mailing address:
  • Phone: 352-266-6199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH4298
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: