Provider Demographics
NPI:1255439949
Name:FAKHOURY, JAMAL A (DC, FACO)
Entity type:Individual
Prefix:DR
First Name:JAMAL
Middle Name:A
Last Name:FAKHOURY
Suffix:
Gender:M
Credentials:DC, FACO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 SE 37TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-9037
Mailing Address - Country:US
Mailing Address - Phone:352-266-6199
Mailing Address - Fax:
Practice Address - Street 1:4710 SE 37TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34480-9037
Practice Address - Country:US
Practice Address - Phone:352-266-6199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4298111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT85812Medicare UPIN
FL88076XMedicare ID - Type Unspecified