Provider Demographics
NPI:1033124524
Name:AJAJ, MUSA
Entity Type:Individual
Prefix:
First Name:MUSA
Middle Name:
Last Name:AJAJ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 E WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-4532
Mailing Address - Country:US
Mailing Address - Phone:215-457-4422
Mailing Address - Fax:215-457-4410
Practice Address - Street 1:441 E WYOMING AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-4532
Practice Address - Country:US
Practice Address - Phone:215-457-4422
Practice Address - Fax:215-457-4410
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006475L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAJ696397Medicare ID - Type Unspecified