Provider Demographics
NPI:1508261298
Name:EL-GENEDY, HAYTHAM (DC)
Entity Type:Individual
Prefix:
First Name:HAYTHAM
Middle Name:
Last Name:EL-GENEDY
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 1:319 VETERANS PAKWY BOLINGBROOK
Mailing Address - Street 2:
Mailing Address - City:AUROURA
Mailing Address - State:IL
Mailing Address - Zip Code:60490
Mailing Address - Country:US
Mailing Address - Phone:630-649-4632
Mailing Address - Fax:
Practice Address - Street 1:319 VETERANS PAKWY BOLINGBROOK
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490
Practice Address - Country:US
Practice Address - Phone:630-649-4632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012672111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor