Provider Demographics
NPI:1457492977
Name:HILALY, AHMED AZAHAR (DC)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:AZAHAR
Last Name:HILALY
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 1:3301 W MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-6218
Mailing Address - Country:US
Mailing Address - Phone:618-277-1774
Mailing Address - Fax:618-277-1775
Practice Address - Street 1:3301 W MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-6218
Practice Address - Country:US
Practice Address - Phone:618-277-1774
Practice Address - Fax:618-277-1775
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor