Provider Demographics
NPI:1881219418
Name:AYYAD, MUSA (DC)
Entity Type:Individual
Prefix:
First Name:MUSA
Middle Name:
Last Name:AYYAD
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 1:186 SWALLOW AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1369
Mailing Address - Country:US
Mailing Address - Phone:224-520-3852
Mailing Address - Fax:
Practice Address - Street 1:186 SWALLOW AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1369
Practice Address - Country:US
Practice Address - Phone:224-520-3852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor