=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629246921
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EAST ISA KHAIIL BELION D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2008
-----------------------------------------------------
Last Update Date | 06/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6029 E HIGHWAY 98
-----------------------------------------------------
City | PANAMA CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32404-7488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-784-6075
-----------------------------------------------------
Fax | 850-784-9422
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 452
-----------------------------------------------------
City | PANAMA CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32402-0452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-764-6075
-----------------------------------------------------
Fax | 850-784-9422
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH7502
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------