Provider Demographics
NPI:1649280009
Name:KHOURY CHIROPRACTC, INC.
Entity type:Organization
Organization Name:KHOURY CHIROPRACTC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WASSIM
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:KHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-329-3344
Mailing Address - Street 1:640 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-4453
Mailing Address - Country:US
Mailing Address - Phone:781-329-3344
Mailing Address - Fax:781-329-3096
Practice Address - Street 1:640 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-4453
Practice Address - Country:US
Practice Address - Phone:781-329-3344
Practice Address - Fax:781-329-3096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1986111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY49082Medicare PIN