Provider Demographics
NPI:1790391860
Name:DASSOUKI, FERRAS (DC)
Entity Type:Individual
Prefix:DR
First Name:FERRAS
Middle Name:
Last Name:DASSOUKI
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 1:1126 HUNTER CT
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-3180
Mailing Address - Country:US
Mailing Address - Phone:313-645-0930
Mailing Address - Fax:
Practice Address - Street 1:25899 W 12 MILE RD STE 335
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-8343
Practice Address - Country:US
Practice Address - Phone:313-645-0930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor