Provider Demographics
NPI:1629246921
Name:BELION, EAST ISA KHAIIL (DC)
Entity Type:Individual
Prefix:DR
First Name:EAST ISA
Middle Name:KHAIIL
Last Name:BELION
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ISA
Other - Middle Name:KHALIL
Other - Last Name:BELION
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 452
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32402-0452
Mailing Address - Country:US
Mailing Address - Phone:850-764-6075
Mailing Address - Fax:850-784-9422
Practice Address - Street 1:6029 E HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-7488
Practice Address - Country:US
Practice Address - Phone:850-784-6075
Practice Address - Fax:850-784-9422
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7502111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381110700Medicaid
FL55777Medicare PIN