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General NPI Number Information
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NPI Number | 1508261298
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Entity Type | Individual
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Provider Name | HAYTHAM EL-GENEDY DC
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Gender | Male
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Dates
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Enumeration Date | 10/24/2014
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Last Update Date | 10/24/2014
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Provider Practice Location Address
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Address Line | 319 VETERANS PAKWY BOLINGBROOK
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City | BOLINGBROOK
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State | IL
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Zip | 60490
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Country | US
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Telephone | 630-649-4632
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Fax |
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Provider Business Mailing Address
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Address Line | 319 VETERANS PAKWY BOLINGBROOK
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City | AUROURA
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State | IL
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Zip | 60490
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Country | US
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Telephone | 630-649-4632
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038.012672
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License Number State | IL
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