Provider Demographics
NPI:1740599877
Name:MUNASSAR, MOHAMED JAMIL (DC)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:JAMIL
Last Name:MUNASSAR
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 1:4214 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-5877
Mailing Address - Country:US
Mailing Address - Phone:716-903-0008
Mailing Address - Fax:
Practice Address - Street 1:4214 CLINTON ST
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-5877
Practice Address - Country:US
Practice Address - Phone:716-903-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011908-1111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition