Provider Demographics
NPI:1922372960
Name:INSHAN, MOHAMED TARIQ (DC)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:TARIQ
Last Name:INSHAN
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 1:4721 WINDSOR AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-3554
Mailing Address - Country:US
Mailing Address - Phone:321-287-1996
Mailing Address - Fax:
Practice Address - Street 1:4721 WINDSOR AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-3554
Practice Address - Country:US
Practice Address - Phone:321-287-1996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10519111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor