Provider Demographics
NPI:1104852490
Name:ABUGHAZALEH, ALI H (DC)
Entity Type:Individual
Prefix:MR
First Name:ALI
Middle Name:H
Last Name:ABUGHAZALEH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 685
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-0685
Mailing Address - Country:US
Mailing Address - Phone:916-784-7500
Mailing Address - Fax:916-784-6319
Practice Address - Street 1:1421 SECRET RAVINE PARKWAY
Practice Address - Street 2:SUITE 111
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661
Practice Address - Country:US
Practice Address - Phone:916-784-7500
Practice Address - Fax:916-784-6319
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor