Provider Demographics
NPI:1942206198
Name:KHAN, MAQBULUR R (DC)
Entity Type:Individual
Prefix:
First Name:MAQBULUR
Middle Name:R
Last Name:KHAN
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 1:23111 E MAIN ST
Mailing Address - Street 2:PO BOX 479
Mailing Address - City:ARMADA
Mailing Address - State:MI
Mailing Address - Zip Code:48005-4706
Mailing Address - Country:US
Mailing Address - Phone:586-784-9127
Mailing Address - Fax:586-784-9129
Practice Address - Street 1:23111 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ARMADA
Practice Address - State:MI
Practice Address - Zip Code:48005-4706
Practice Address - Country:US
Practice Address - Phone:586-784-9127
Practice Address - Fax:586-784-9129
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E01761OtherBCN
MI0E01761OtherBCBSM
MI4813870Medicaid
MI0E01761OtherBCN