Healthcare Provider Details

I. General information

NPI: 1841357316
Provider Name (Legal Business Name): ROSELLE CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 08/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 IRVING PARK RD
ROSELLE IL
60172
US

IV. Provider business mailing address

50 IRVING PARK RD
ROSELLE IL
60172
US

V. Phone/Fax

Practice location:
  • Phone: 630-295-8851
  • Fax: 630-295-8852
Mailing address:
  • Phone: 630-295-8851
  • Fax: 630-295-8852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-008665
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number209.006668
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038012771
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: TARIQ AHMED
Title or Position: OWNER
Credential: DC
Phone: 630-295-8851