Healthcare Provider Details

I. General information

NPI: 1467931121
Provider Name (Legal Business Name): FOUAD JEAN RAAD DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 LITTLE RD
TRINITY FL
34655-4421
US

IV. Provider business mailing address

2500 WINDING CREEK BLVD APT G102
CLEARWATER FL
33761-4322
US

V. Phone/Fax

Practice location:
  • Phone: 727-375-7557
  • Fax:
Mailing address:
  • Phone: 716-491-0551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH12512
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: