Provider Demographics
NPI:1780462895
Name:ABDELRAHMAN, MOHAMED ELTAHIR (DC)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:ELTAHIR
Last Name:ABDELRAHMAN
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 1:1105 CLARA AVE APT 2111
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-2894
Mailing Address - Country:US
Mailing Address - Phone:443-365-7098
Mailing Address - Fax:
Practice Address - Street 1:13305 PANAMA CITY BEACH PKWY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-2844
Practice Address - Country:US
Practice Address - Phone:850-234-2242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor