MEDICARE: DR. MOHAMMAD JOUDEH D.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	038.012499	IL
2	225100000X	Physical Therapist		IL

General Provider Information

NPI Number	:	1538594395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMAD JOUDEH D.C

Provider Business Mailing Address
First Line	:	1000 BURR RIDGE PKWY STE 200
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-0845
Country	:	US
Telephone Number	:	630-920-4670
Fax Number	:	630-920-4687

Provider Business Practice Location Address
First Line	:	4844 S CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638
Country	:	US
Telephone Number	:	630-920-4670
Fax Number	:	630-920-4687

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2013
Last Update Date	:	07/24/2018

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