Provider Demographics
NPI:1730119637
Name:FAKHOURY, RIADH A (DC)
Entity Type:Individual
Prefix:DR
First Name:RIADH
Middle Name:A
Last Name:FAKHOURY
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 1:1009 SW 16TH LN
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1228
Mailing Address - Country:US
Mailing Address - Phone:352-351-3413
Mailing Address - Fax:352-629-6667
Practice Address - Street 1:1009 SW 16TH LN
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1228
Practice Address - Country:US
Practice Address - Phone:352-351-3413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004912111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70600OtherBCBS FLORIDA
FL70600OtherBCBS FLORIDA
FL70600ZMedicare PIN