Provider Demographics
NPI:1417908443
Name:KHOURI, STEPHEN ABRAHAM (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ABRAHAM
Last Name:KHOURI
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 1:149 E BAY ST
Mailing Address - Street 2:100
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-2104
Mailing Address - Country:US
Mailing Address - Phone:843-722-7074
Mailing Address - Fax:843-722-9749
Practice Address - Street 1:149 E BAY ST
Practice Address - Street 2:100
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-2104
Practice Address - Country:US
Practice Address - Phone:843-722-7074
Practice Address - Fax:843-722-9749
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2726111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor