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General NPI Number Information
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NPI Number | 1063618973
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Entity Type | Organization
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Legal Business Name | MIDWEST NEUROLODIAGNOSTIC SPECIALISTS
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3358 W 26TH ST
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City | CHICAGO
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State | IL
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Zip | 60623-4037
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Country | US
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Telephone | 773-522-3926
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Fax | 773-522-1343
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Provider Business Mailing Address
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Address Line | 3358 W 26TH ST
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City | CHICAGO
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State | IL
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Zip | 60623-4037
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Country | US
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Telephone | 773-522-3926
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Fax | 773-522-1343
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Authorized Official
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Title or Position | NEUROLOGIST
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Name | DR. CARLOS HALWAJI I
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Credential | DC
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Telephone | 773-522-3926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN0400X
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Taxonomy Name | Neurology Chiropractor
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License Number | 4121012
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 111NN0400X
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Taxonomy Name | Neurology Chiropractor
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License Number |
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License Number State | IL
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