Provider Demographics
NPI:1588395040
Name:KHAN, ASIF (DC)
Entity type:Individual
Prefix:
First Name:ASIF
Middle Name:
Last Name:KHAN
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 1:1440 DOVER RD APT A
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-1350
Mailing Address - Country:US
Mailing Address - Phone:609-318-4777
Mailing Address - Fax:
Practice Address - Street 1:3015 SW PINE ISLAND RD STE 111
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-1704
Practice Address - Country:US
Practice Address - Phone:239-610-5042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14075111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor