Provider Demographics
NPI:1275562175
Name:ABOUHAIF, KHALED M (DC)
Entity Type:Individual
Prefix:DR
First Name:KHALED
Middle Name:M
Last Name:ABOUHAIF
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 1:919 DUAL HALL CT
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-6970
Mailing Address - Country:US
Mailing Address - Phone:770-419-1028
Mailing Address - Fax:770-419-1447
Practice Address - Street 1:310 GOLD CREEK TRL
Practice Address - Street 2:STE 100
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-5403
Practice Address - Country:US
Practice Address - Phone:770-926-9495
Practice Address - Fax:770-926-9284
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007348111N00000X
GACHIR008019111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0980481OtherHEALTHPLUS
MI350045598OtherMEDICARE RAILROAD
MI3334395Medicaid
MI133505OtherPREFERRED CHOICES
MI383374689OtherPPOM
MI1002612OtherMCLAREN HEALTH
MI4400101OtherPHYSICIANS HEALTHPLAN
MI1016842-0001OtherWELLNESS
MI5183617OtherAETNA
MIKA007348OtherBCBSM
MI5183617OtherAETNA
MI0980481OtherHEALTHPLUS
MI1002612OtherMCLAREN HEALTH
MI350045598OtherMEDICARE RAILROAD
MI3334395Medicaid