Provider Demographics
NPI:1588793426
Name:DAHDAH, KYZOR M (DC)
Entity type:Individual
Prefix:DR
First Name:KYZOR
Middle Name:M
Last Name:DAHDAH
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 1:6846 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-4011
Mailing Address - Country:US
Mailing Address - Phone:954-474-3919
Mailing Address - Fax:954-474-1799
Practice Address - Street 1:6846 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4011
Practice Address - Country:US
Practice Address - Phone:954-474-3919
Practice Address - Fax:954-474-1799
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6353111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380174800Medicaid
U20129Medicare UPIN
FL380174800Medicaid