Provider Demographics
NPI:1639392707
Name:ALMASMARI, KHALID (DC)
Entity Type:Individual
Prefix:
First Name:KHALID
Middle Name:
Last Name:ALMASMARI
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 1:9743 CONANT ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3306
Mailing Address - Country:US
Mailing Address - Phone:313-874-3130
Mailing Address - Fax:313-874-3178
Practice Address - Street 1:9743 CONANT ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3306
Practice Address - Country:US
Practice Address - Phone:313-874-3130
Practice Address - Fax:313-874-3178
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007986111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H253920OtherBCBSM
MI950H253920OtherBCBSM
MI0M95370Medicare ID - Type UnspecifiedMEDICARE