Provider Demographics
NPI:1679697700
Name:HABIBI, KAM (DC)
Entity Type:Individual
Prefix:DR
First Name:KAM
Middle Name:
Last Name:HABIBI
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 1:6765 SUNSET STRIP
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33313-2894
Mailing Address - Country:US
Mailing Address - Phone:954-742-0771
Mailing Address - Fax:954-742-6322
Practice Address - Street 1:6765 SUNSET STRIP
Practice Address - Street 2:SUITE 1
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33313-2894
Practice Address - Country:US
Practice Address - Phone:954-742-0771
Practice Address - Fax:954-742-6322
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7527111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor