Provider Demographics
NPI:1457490260
Name:GANEM, RAYMOND EMILE (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:EMILE
Last Name:GANEM
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 1:4482 BARRANCA PKWY
Mailing Address - Street 2:SUITE 192
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-7701
Mailing Address - Country:US
Mailing Address - Phone:949-552-5094
Mailing Address - Fax:949-552-5096
Practice Address - Street 1:4482 BARRANCA PKWY
Practice Address - Street 2:SUITE 192
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-7701
Practice Address - Country:US
Practice Address - Phone:949-552-5094
Practice Address - Fax:949-552-5096
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-24373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor