Healthcare Provider Details

I. General information

NPI: 1063618973
Provider Name (Legal Business Name): MIDWEST NEUROLODIAGNOSTIC SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3358 W 26TH ST
CHICAGO IL
60623-4037
US

IV. Provider business mailing address

3358 W 26TH ST
CHICAGO IL
60623-4037
US

V. Phone/Fax

Practice location:
  • Phone: 773-522-3926
  • Fax: 773-522-1343
Mailing address:
  • Phone: 773-522-3926
  • Fax: 773-522-1343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number4121012
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. CARLOS HALWAJI I
Title or Position: NEUROLOGIST
Credential: DC
Phone: 773-522-3926