Provider Demographics
NPI:1700525482
Name:GHADBAN, ADAM MOUNIR
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:MOUNIR
Last Name:GHADBAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 BARANOVA RD
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-1826
Mailing Address - Country:US
Mailing Address - Phone:470-786-8211
Mailing Address - Fax:
Practice Address - Street 1:425 ALEXANDRIA BLVD
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-5548
Practice Address - Country:US
Practice Address - Phone:844-699-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14040111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor