Healthcare Provider Details

I. General information

NPI: 1942206198
Provider Name (Legal Business Name): MAQBULUR R KHAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23111 E MAIN ST
ARMADA MI
48005-4706
US

IV. Provider business mailing address

23111 E MAIN ST PO BOX 479
ARMADA MI
48005-4706
US

V. Phone/Fax

Practice location:
  • Phone: 586-784-9127
  • Fax: 586-784-9129
Mailing address:
  • Phone: 586-784-9127
  • Fax: 586-784-9129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301006047
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: