Provider Demographics
NPI:1669510061
Name:AKHTAR, WAJAHAT (DC)
Entity Type:Individual
Prefix:DR
First Name:WAJAHAT
Middle Name:
Last Name:AKHTAR
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 1:3253 HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2996
Mailing Address - Country:US
Mailing Address - Phone:708-788-3880
Mailing Address - Fax:708-788-4757
Practice Address - Street 1:3253 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2996
Practice Address - Country:US
Practice Address - Phone:708-788-3880
Practice Address - Fax:708-788-4757
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK36211Medicare UPIN