Provider Demographics
NPI:1447565874
Name:IDRISS, GHAZI SAMIR (DC)
Entity Type:Individual
Prefix:DR
First Name:GHAZI
Middle Name:SAMIR
Last Name:IDRISS
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 1:7212 ORANGETHORPE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-4660
Mailing Address - Country:US
Mailing Address - Phone:714-562-0966
Mailing Address - Fax:888-789-3197
Practice Address - Street 1:7212 ORANGETHORPE AVE STE 3
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-4660
Practice Address - Country:US
Practice Address - Phone:714-562-0966
Practice Address - Fax:888-789-3197
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor