Provider Demographics
NPI:1083953566
Name:ELKHIAR, ELMOSTAFA
Entity Type:Individual
Prefix:
First Name:ELMOSTAFA
Middle Name:
Last Name:ELKHIAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ELMOSTAFA
Other - Middle Name:
Other - Last Name:ELKHIAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:235 N LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3500
Mailing Address - Country:US
Mailing Address - Phone:909-988-2554
Mailing Address - Fax:909-988-2584
Practice Address - Street 1:235 N LAUREL AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3500
Practice Address - Country:US
Practice Address - Phone:909-988-2554
Practice Address - Fax:909-988-2584
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26862111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health