Healthcare Provider Details

I. General information

NPI: 1679231062
Provider Name (Legal Business Name): OOWAIS SIDDIQUE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 S MAIN ST # C
LOMBARD IL
60148-2610
US

IV. Provider business mailing address

145 S MAIN ST # C
LOMBARD IL
60148-2610
US

V. Phone/Fax

Practice location:
  • Phone: 630-426-9348
  • Fax:
Mailing address:
  • Phone: 630-426-9348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.013708
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: