Provider Demographics
NPI:1093129637
Name:DAOUD'S PROKINETIC SPORTS CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:DAOUD'S PROKINETIC SPORTS CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAOUD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-834-8725
Mailing Address - Street 1:73140 HIGHWAY 111
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3927
Mailing Address - Country:US
Mailing Address - Phone:760-834-8725
Mailing Address - Fax:
Practice Address - Street 1:73140 HIGHWAY 111
Practice Address - Street 2:STE 8
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3927
Practice Address - Country:US
Practice Address - Phone:760-834-8725
Practice Address - Fax:760-834-8725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty