Provider Demographics
NPI:1891333944
Name:CABBLER, ARIQ
Entity Type:Individual
Prefix:MR
First Name:ARIQ
Middle Name:
Last Name:CABBLER
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 1:5642 S PRAIRIE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1575
Mailing Address - Country:US
Mailing Address - Phone:773-824-6228
Mailing Address - Fax:
Practice Address - Street 1:5642 S PRAIRIE AVE APT 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1575
Practice Address - Country:US
Practice Address - Phone:773-824-6228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1418000405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional