Provider Demographics
NPI:1972585297
Name:FAKHOURY, SAYEL S (DC)
Entity Type:Individual
Prefix:DR
First Name:SAYEL
Middle Name:S
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 1:18399 VENTURA BLVD
Mailing Address - Street 2:SUITE 241
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4233
Mailing Address - Country:US
Mailing Address - Phone:818-708-0477
Mailing Address - Fax:818-708-7902
Practice Address - Street 1:18399 VENTURA BLVD
Practice Address - Street 2:SUITE 241
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4233
Practice Address - Country:US
Practice Address - Phone:818-708-0477
Practice Address - Fax:818-708-7902
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20968111N00000X, 111NS0005X, 111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC20968OtherCHIROPRATIC LICENSE
CA952070OtherQME LICENSE