Provider Demographics
NPI:1265103147
Name:ABOUAKL, ZEINA
Entity type:Individual
Prefix:
First Name:ZEINA
Middle Name:
Last Name:ABOUAKL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2335 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3575
Mailing Address - Country:US
Mailing Address - Phone:909-982-9100
Mailing Address - Fax:
Practice Address - Street 1:2335 W FOOTHILL BLVD STE 20
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3577
Practice Address - Country:US
Practice Address - Phone:909-982-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36160111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNON PARTICIPATING CHIROPRACTIC OFFICE
1265103147OtherCHIROPRACTIC