Provider Demographics
NPI:1942390323
Name:LEMNOUNI, SIDI M (DC)
Entity Type:Individual
Prefix:
First Name:SIDI
Middle Name:M
Last Name:LEMNOUNI
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:PO BOX 2400
Mailing Address - Street 2:
Mailing Address - City:FLAGLER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32136-2400
Mailing Address - Country:US
Mailing Address - Phone:386-439-9001
Mailing Address - Fax:386-439-9002
Practice Address - Street 1:1240 SOUTH A1A
Practice Address - Street 2:
Practice Address - City:FLAGLER BEACH
Practice Address - State:FL
Practice Address - Zip Code:32136
Practice Address - Country:US
Practice Address - Phone:386-439-9001
Practice Address - Fax:396-439-9002
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0003501111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22770OtherBCBS
FL22770Medicare ID - Type Unspecified
FL22770OtherBCBS