Provider Demographics
NPI:1164619870
Name:DR RIADH A FAKHOURY DC PA
Entity Type:Organization
Organization Name:DR RIADH A FAKHOURY DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RIADH
Authorized Official - Middle Name:A
Authorized Official - Last Name:FAKHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-351-3413
Mailing Address - Street 1:1009 SW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471
Mailing Address - Country:US
Mailing Address - Phone:352-351-3413
Mailing Address - Fax:352-629-6667
Practice Address - Street 1:1009 SW 17TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1229
Practice Address - Country:US
Practice Address - Phone:352-351-3413
Practice Address - Fax:352-629-6667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004942111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL350039676OtherRAILROAD MEDICARE
FLK0566Medicare PIN