Provider Demographics
NPI:1285848523
Name:NADDAF, JAMILEH (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMILEH
Middle Name:
Last Name:NADDAF
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 W VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2259
Mailing Address - Country:US
Mailing Address - Phone:217-347-3838
Mailing Address - Fax:217-347-3832
Practice Address - Street 1:415 W VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2259
Practice Address - Country:US
Practice Address - Phone:217-347-3838
Practice Address - Fax:217-347-3832
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-06308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL752822OtherHEALTHLINK
IL4015002OtherBLUE CROSS BLUE SHIELD
ILU20120Medicare UPIN
IL752822OtherHEALTHLINK