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General NPI Number Information
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NPI Number | 1083809842
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Entity Type | Organization
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Legal Business Name | JAMAL A FAKHOURY DC PA
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 2320 N SUNSHINE PATH
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City | CRYSTAL RIVER
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State | FL
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Zip | 34428-5810
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Country | US
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Telephone | 352-795-5350
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Fax | 352-795-7487
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Provider Business Mailing Address
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Address Line | 2320 N SUNSHINE PATH
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City | CRYSTAL RIVER
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State | FL
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Zip | 34428-5810
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Country | US
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Telephone | 352-795-5350
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Fax | 352-795-7487
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. JAMAL A FAKHOURY
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Credential | DC
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Telephone | 352-795-5350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH4298
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License Number State | FL
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