Provider Demographics
NPI:1669686879
Name:AL-SHIFA HEALTH CENTER P C
Entity Type:Organization
Organization Name:AL-SHIFA HEALTH CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALEED
Authorized Official - Middle Name:
Authorized Official - Last Name:GABR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-679-0276
Mailing Address - Street 1:319 VETERANS PKWY # B
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-3132
Mailing Address - Country:US
Mailing Address - Phone:630-679-0276
Mailing Address - Fax:630-679-0316
Practice Address - Street 1:319 VETERANS PKWY # B
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-3132
Practice Address - Country:US
Practice Address - Phone:630-679-0276
Practice Address - Fax:630-679-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009289111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207885Medicare PIN