Provider Demographics
NPI:1831140573
Name:MASUD, SHERYAR (DC)
Entity Type:Individual
Prefix:MR
First Name:SHERYAR
Middle Name:
Last Name:MASUD
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 1:525 TYLER RD
Mailing Address - Street 2:UNIT R-1
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-3305
Mailing Address - Country:US
Mailing Address - Phone:630-443-4411
Mailing Address - Fax:630-443-7351
Practice Address - Street 1:525 TYLER RD
Practice Address - Street 2:UNIT R-1
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-3305
Practice Address - Country:US
Practice Address - Phone:630-443-4411
Practice Address - Fax:630-443-7351
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04527125OtherBLUE CROSS BLUE SHIELD
IL04527125OtherBLUE CROSS BLUE SHIELD