Provider Demographics
NPI:1821175399
Name:RAHEEM, SHAMSU K (DC)
Entity Type:Individual
Prefix:MR
First Name:SHAMSU
Middle Name:K
Last Name:RAHEEM
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 1:231 E 75TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-2267
Mailing Address - Country:US
Mailing Address - Phone:773-651-8010
Mailing Address - Fax:773-651-8047
Practice Address - Street 1:231 E 75TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-2267
Practice Address - Country:US
Practice Address - Phone:773-651-8010
Practice Address - Fax:773-651-8047
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14-1925106111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1635092OtherBLUE CROSS BLUE SHIELD
IL212664Medicare ID - Type Unspecified
IL1635092OtherBLUE CROSS BLUE SHIELD