Provider Demographics
NPI:1679231062
Name:SIDDIQUE, OOWAIS (DC)
Entity Type:Individual
Prefix:
First Name:OOWAIS
Middle Name:
Last Name:SIDDIQUE
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 1:221 HAMPSHIRE CT UNIT 102A
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-4271
Mailing Address - Country:US
Mailing Address - Phone:630-280-0004
Mailing Address - Fax:
Practice Address - Street 1:221 HAMPSHIRE CT UNIT 102A
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-4271
Practice Address - Country:US
Practice Address - Phone:630-280-0004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2023-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013708111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor