Provider Demographics
NPI:1215616149
Name:ABDERHMAN, OMAR (DC)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:ABDERHMAN
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3342 MANDARIN GLEN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-7823
Mailing Address - Country:US
Mailing Address - Phone:571-353-8542
Mailing Address - Fax:
Practice Address - Street 1:9428 BAYMEADOWS RD STE 250
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7970
Practice Address - Country:US
Practice Address - Phone:904-795-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14605111N00000X, 111NI0013X, 111NX0100X, 111NX0800X, 111NN0400X, 111NR0200X, 111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
No111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
No111NN0400XChiropractic ProvidersChiropractorNeurology
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician