Provider Demographics
NPI:1750448320
Name:AHMED, TARIQ (DC)
Entity Type:Individual
Prefix:
First Name:TARIQ
Middle Name:
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 1:50 IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172
Mailing Address - Country:US
Mailing Address - Phone:630-295-8851
Mailing Address - Fax:630-295-8852
Practice Address - Street 1:50 IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172
Practice Address - Country:US
Practice Address - Phone:630-295-8851
Practice Address - Fax:630-295-8852
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008665111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2232174OtherBCBS OF IL
IL038008665Medicaid
ILK19031Medicare PIN