Provider Demographics
NPI:1457479016
Name:CHIRODOC,LLC
Entity Type:Organization
Organization Name:CHIRODOC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:HILALY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-277-1774
Mailing Address - Street 1:3301 W MAIN ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-6218
Mailing Address - Country:US
Mailing Address - Phone:618-277-1774
Mailing Address - Fax:618-277-1775
Practice Address - Street 1:3301 W MAIN ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-6218
Practice Address - Country:US
Practice Address - Phone:618-277-1774
Practice Address - Fax:618-277-1775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.010851111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty