Provider Demographics
NPI:1760598171
Name:OUAIS, BRAHIM (DC)
Entity Type:Individual
Prefix:
First Name:BRAHIM
Middle Name:
Last Name:OUAIS
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 1:106 S LINCOLNWAY STE C
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-1597
Mailing Address - Country:US
Mailing Address - Phone:630-879-9300
Mailing Address - Fax:630-897-0727
Practice Address - Street 1:106 S LINCOLNWAY STE C
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-1597
Practice Address - Country:US
Practice Address - Phone:630-879-9300
Practice Address - Fax:630-897-0727
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1760598171Medicaid
MI950G31270OtherBLUE CROSS BLUE SHIELD OF MI
MI1760598171Medicaid