Provider Demographics
NPI:1104028265
Name:AMA CHIROPRACTIC ALTERNATIVE SERVICES PC
Entity Type:Organization
Organization Name:AMA CHIROPRACTIC ALTERNATIVE SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FAROOK
Authorized Official - Middle Name:
Authorized Official - Last Name:MUHIUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-288-7518
Mailing Address - Street 1:38 COBBLESTONE LN
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-1496
Mailing Address - Country:US
Mailing Address - Phone:618-288-7518
Mailing Address - Fax:618-692-9772
Practice Address - Street 1:340 SOUTH FILLMORE ST
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025
Practice Address - Country:US
Practice Address - Phone:618-692-9763
Practice Address - Fax:618-692-9772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7233470OtherAETNA
IL5675679OtherFIRST HEALTH
IL672256OtherUHC
IL719909OtherHEALTHLINK
MO202370OtherBCBS
ILPOO264483OtherRRMEDICARE
IL9516006OtherCIGNA
IL06032164OtherBCBS
IL719909OtherHEALTHLINK
MO202370OtherBCBS