Provider Demographics
NPI:1134123557
Name:GHAYOUMI, ABDOL (DC)
Entity Type:Individual
Prefix:DR
First Name:ABDOL
Middle Name:
Last Name:GHAYOUMI
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 1:1074 PEDIGO WAY
Mailing Address - Street 2:STE 200
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-7206
Mailing Address - Country:US
Mailing Address - Phone:270-782-0267
Mailing Address - Fax:270-782-0269
Practice Address - Street 1:1074 PEDIGO WAY
Practice Address - Street 2:STE 200
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-7206
Practice Address - Country:US
Practice Address - Phone:270-782-0267
Practice Address - Fax:270-782-0269
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2008-06-27
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
KY3864111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85036614Medicaid
KY85036614Medicaid
KY6046602Medicare PIN