Provider Demographics
NPI:1740486240
Name:EL SOUKI, ISMAT D (DC)
Entity type:Individual
Prefix:DR
First Name:ISMAT
Middle Name:D
Last Name:EL SOUKI
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 1:12614 SPARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638
Mailing Address - Country:US
Mailing Address - Phone:323-724-3777
Mailing Address - Fax:323-724-9147
Practice Address - Street 1:709 W BEVERLY BLVD
Practice Address - Street 2:#203
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640
Practice Address - Country:US
Practice Address - Phone:323-724-3777
Practice Address - Fax:323-724-9147
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21956111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19386Medicare ID - Type Unspecified