Provider Demographics
NPI:1285649046
Name:SHALABI, MOHAMED (DC)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:
Last Name:SHALABI
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 1:12750 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2173
Mailing Address - Country:US
Mailing Address - Phone:708-598-2000
Mailing Address - Fax:708-598-2002
Practice Address - Street 1:8550 S HARLEM AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BRIDGEVIEW
Practice Address - State:IL
Practice Address - Zip Code:60455-1770
Practice Address - Country:US
Practice Address - Phone:708-598-2000
Practice Address - Fax:708-598-2002
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU88504Medicare UPIN
ILK06032Medicare ID - Type Unspecified