Healthcare Provider Details

I. General information

NPI: 1285649046
Provider Name (Legal Business Name): MOHAMED SHALABI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 S HARLEM AVE SUITE B
BRIDGEVIEW IL
60455-1770
US

IV. Provider business mailing address

12750 S HARLEM AVE
PALOS HEIGHTS IL
60463-2173
US

V. Phone/Fax

Practice location:
  • Phone: 708-598-2000
  • Fax: 708-598-2002
Mailing address:
  • Phone: 708-598-2000
  • Fax: 708-598-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038009550
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: