Provider Demographics
NPI:1245320688
Name:TALEBNIA, MOONESS (DC)
Entity type:Individual
Prefix:DR
First Name:MOONESS
Middle Name:
Last Name:TALEBNIA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 LAKE GILLILAN WAY
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5015
Mailing Address - Country:US
Mailing Address - Phone:847-658-1805
Mailing Address - Fax:847-490-7066
Practice Address - Street 1:1007 W GOLF RD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60194-1339
Practice Address - Country:US
Practice Address - Phone:847-490-7000
Practice Address - Fax:847-490-7066
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207509Medicare ID - Type Unspecified
ILU97551Medicare UPIN