Provider Demographics
NPI:1073156238
Name:BLEIBEL, OMAR A (DC)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:A
Last Name:BLEIBEL
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 1:4801 W PETERSON AVE STE 505
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5795
Mailing Address - Country:US
Mailing Address - Phone:855-484-3349
Mailing Address - Fax:
Practice Address - Street 1:4801 W PETERSON AVE STE 505
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5795
Practice Address - Country:US
Practice Address - Phone:855-484-3349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor