Provider Demographics
NPI:1578966230
Name:ALALOUL, JAMAL
Entity Type:Individual
Prefix:
First Name:JAMAL
Middle Name:
Last Name:ALALOUL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 N BURR OAK RD
Mailing Address - Street 2:
Mailing Address - City:COLON
Mailing Address - State:MI
Mailing Address - Zip Code:49040-9403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:521 N BURR OAK RD
Practice Address - Street 2:
Practice Address - City:COLON
Practice Address - State:MI
Practice Address - Zip Code:49040-9403
Practice Address - Country:US
Practice Address - Phone:269-432-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor