Provider Demographics
NPI:1821137944
Name:AWWAD, MAHIR HANNA (DC)
Entity Type:Individual
Prefix:MR
First Name:MAHIR
Middle Name:HANNA
Last Name:AWWAD
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 1:2201 1ST CAPITOL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-5805
Mailing Address - Country:US
Mailing Address - Phone:636-916-0660
Mailing Address - Fax:636-916-0668
Practice Address - Street 1:2201 1ST CAPITOL DR STE 100
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-5805
Practice Address - Country:US
Practice Address - Phone:636-916-0660
Practice Address - Fax:636-916-0668
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003009369111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO187745OtherBLUE CROSS BLUE SHIELD
MO0000Z5603Medicare ID - Type Unspecified