Provider Demographics
NPI:1972716132
Name:KHOURY, VICTOR J (DC)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:J
Last Name:KHOURY
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 1:5225 N 19TH AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2903
Mailing Address - Country:US
Mailing Address - Phone:602-274-8444
Mailing Address - Fax:602-274-8445
Practice Address - Street 1:5225 N 19TH AVE
Practice Address - Street 2:SUITE E
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2903
Practice Address - Country:US
Practice Address - Phone:602-274-8444
Practice Address - Fax:602-274-8445
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDC5499Medicare ID - Type Unspecified