Provider Demographics
NPI:1588150445
Name:KHALAF, ANAS ANIS (DC)
Entity type:Individual
Prefix:
First Name:ANAS
Middle Name:ANIS
Last Name:KHALAF
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:PO BOX 41555
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33743-1555
Mailing Address - Country:US
Mailing Address - Phone:321-689-3888
Mailing Address - Fax:
Practice Address - Street 1:6740 CROSSWINDS DR N STE A
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-5472
Practice Address - Country:US
Practice Address - Phone:321-689-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3345111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor