Provider Demographics
NPI:1659790806
Name:KHAN, BILAL (DC)
Entity Type:Individual
Prefix:DR
First Name:BILAL
Middle Name:
Last Name:KHAN
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 1:5842 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-2622
Mailing Address - Country:US
Mailing Address - Phone:773-283-3636
Mailing Address - Fax:773-283-0091
Practice Address - Street 1:5842 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-2622
Practice Address - Country:US
Practice Address - Phone:773-283-3636
Practice Address - Fax:773-283-0091
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400144373Medicare PIN