Provider Demographics
NPI:1245350396
Name:KHOURY, ANDRE ELIE (DC)
Entity type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:ELIE
Last Name:KHOURY
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 1:15030 VENTURA BLVD
Mailing Address - Street 2:SUITE # 5
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-5470
Mailing Address - Country:US
Mailing Address - Phone:818-784-2278
Mailing Address - Fax:818-784-2270
Practice Address - Street 1:15030 VENTURA BLVD
Practice Address - Street 2:SUITE # 5
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-5470
Practice Address - Country:US
Practice Address - Phone:818-784-2278
Practice Address - Fax:818-784-2270
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC13575111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPIN 0004399228OtherAETNA
CA54220DC0135750OtherBLUE SHIELD OF CALIFORNIA
CADC13575Medicare ID - Type Unspecified