Provider Demographics
NPI:1922521251
Name:PALISADES CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:PALISADES CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAZEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALJUTAILI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:202-558-2101
Mailing Address - Street 1:5185 MACARTHUR BLVD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-3341
Mailing Address - Country:US
Mailing Address - Phone:202-558-2101
Mailing Address - Fax:
Practice Address - Street 1:5185 MACARTHUR BLVD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-3341
Practice Address - Country:US
Practice Address - Phone:202-558-2101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCH030169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty