Provider Demographics
NPI:1356412852
Name:MAKHOOL-FALLOUH, SHEILA MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:MARIE
Last Name:MAKHOOL-FALLOUH
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 1:3033 LENNOX CT
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-8621
Mailing Address - Country:US
Mailing Address - Phone:248-914-8207
Mailing Address - Fax:
Practice Address - Street 1:13530 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3574
Practice Address - Country:US
Practice Address - Phone:313-908-9743
Practice Address - Fax:313-908-9851
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2307006008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU72327Medicare UPIN
MI0P39070Medicare PIN