Provider Demographics
NPI:1396261236
Name:JALLOUL, MOURAD (DC)
Entity type:Individual
Prefix:DR
First Name:MOURAD
Middle Name:
Last Name:JALLOUL
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 1:3506 ROUTE 130
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-3391
Mailing Address - Country:US
Mailing Address - Phone:724-744-0300
Mailing Address - Fax:724-744-0303
Practice Address - Street 1:1150 WILDLIFE LODGE RD
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-3562
Practice Address - Country:US
Practice Address - Phone:724-212-3866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011254111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor