Provider Demographics
NPI:1457408924
Name:HALLOUM, IMAN M (DC)
Entity type:Individual
Prefix:DR
First Name:IMAN
Middle Name:M
Last Name:HALLOUM
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:PO BOX 482
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-0482
Mailing Address - Country:US
Mailing Address - Phone:630-232-2900
Mailing Address - Fax:
Practice Address - Street 1:2401 KANEVILLE RD
Practice Address - Street 2:SUITE 7
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2579
Practice Address - Country:US
Practice Address - Phone:630-232-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL560640Medicare ID - Type Unspecified