Provider Demographics
NPI:1992040752
Name:KHAZAAL CHIROPRACTIC INC
Entity Type:Organization
Organization Name:KHAZAAL CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RADWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAZAAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-551-5232
Mailing Address - Street 1:22030 FORD RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2418
Mailing Address - Country:US
Mailing Address - Phone:313-551-5232
Mailing Address - Fax:313-228-5294
Practice Address - Street 1:22030 FORD RD
Practice Address - Street 2:SUITE B
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2418
Practice Address - Country:US
Practice Address - Phone:313-551-5232
Practice Address - Fax:313-228-5294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007644111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty