Provider Demographics
NPI:1306003728
Name:ABDOL GHAYOUMI DC PSC
Entity Type:Organization
Organization Name:ABDOL GHAYOUMI DC PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:ABDOL
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAYOUMI
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PSC
Authorized Official - Phone:270-782-0267
Mailing Address - Street 1:1074 PEDIGO WAY STE 200
Mailing Address - Street 2:
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 STE 200
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85036614Medicaid
KY85036614Medicaid