=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598310773
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BASSAM SLIBI D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2019
-----------------------------------------------------
Last Update Date | 08/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8551 LA PALMA AVE
-----------------------------------------------------
City | BUENA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90620-2278
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-479-8222
-----------------------------------------------------
Fax | 714-266-0080
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8551 LA PALMA AVE
-----------------------------------------------------
City | BUENA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90620-2278
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-479-8222
-----------------------------------------------------
Fax | 714-266-0080
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 34247
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------