Provider Demographics
NPI:1134137482
Name:KHOURY, WASSIM GEORGE (DC)
Entity Type:Individual
Prefix:DR
First Name:WASSIM
Middle Name:GEORGE
Last Name:KHOURY
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 1:640 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-4453
Mailing Address - Country:US
Mailing Address - Phone:781-329-3344
Mailing Address - Fax:781-329-3096
Practice Address - Street 1:640 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-4427
Practice Address - Country:US
Practice Address - Phone:781-329-3344
Practice Address - Fax:781-329-3096
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1986111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY45052Medicare ID - Type Unspecified