Provider Demographics
NPI:1689604134
Name:AHMED, IMRAN JAMIL (DC)
Entity Type:Individual
Prefix:MR
First Name:IMRAN
Middle Name:JAMIL
Last Name:AHMED
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 1:629 SCHUYLKILL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-1891
Mailing Address - Country:US
Mailing Address - Phone:610-933-6500
Mailing Address - Fax:610-933-1519
Practice Address - Street 1:629 SCHUYLKILL RD
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-1891
Practice Address - Country:US
Practice Address - Phone:610-933-6500
Practice Address - Fax:610-933-1519
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007916L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAV00475Medicare UPIN
PA080985Medicare ID - Type Unspecified