Provider Demographics
NPI:1598851057
Name:GHAYOUMI, MEHDI (DC)
Entity Type:Individual
Prefix:
First Name:MEHDI
Middle Name:
Last Name:GHAYOUMI
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 1:4615 DIXIE HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216
Mailing Address - Country:US
Mailing Address - Phone:502-449-1189
Mailing Address - Fax:
Practice Address - Street 1:4615 DIXIE HWY
Practice Address - Street 2:SUITE A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216
Practice Address - Country:US
Practice Address - Phone:502-449-1189
Practice Address - Fax:502-449-1286
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4247111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85036531Medicaid
KY85036531Medicaid