Provider Demographics
NPI:1871666594
Name:ABDEL-JAWAD, IBRAHIM HUSNI
Entity Type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:HUSNI
Last Name:ABDEL-JAWAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9925 DIX STE 102
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1593
Mailing Address - Country:US
Mailing Address - Phone:313-841-1470
Mailing Address - Fax:313-841-7377
Practice Address - Street 1:9925 DIX STE 102
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1593
Practice Address - Country:US
Practice Address - Phone:313-841-1470
Practice Address - Fax:313-841-7377
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIIA007849111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor