MEDICARE: REHAN SIDDIQUI DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	038-008564	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001622785	OTHER	IL	BCBS PROVIDER #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831246230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REHAN SIDDIQUI DC

Provider Business Mailing Address
First Line	:	3043 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2807
Country	:	US
Telephone Number	:	773-862-3180
Fax Number	:	773-661-0300

Provider Business Practice Location Address
First Line	:	3043 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2807
Country	:	US
Telephone Number	:	773-862-3180
Fax Number	:	773-661-0300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	11/18/2014

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Directions to “ REHAN SIDDIQUI DC” Practice Location

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