Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 20968 | CA |
N | 111NS0005X | Chiropractic Sports Physician | 20968 | CA |
N | 111NX0100X | Occupational Health | 20968 | CA |
NPI | 1972585297 |
---|---|
Provider Name | Dr. Sayel S. Fakhoury |
First Address | Tarzana, CA 91356-4233 |
Second Address | Tarzana, CA 91356-4233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 26/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
952070 | QME LICENSE (01) | CA |
DC20968 | CHIROPRATIC LICENSE (01) | CA |