MEDICARE: MAHER GHATTAS 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	111NR0400X	Rehabilitation Chiropractor	38009171	IL

General Provider Information

NPI Number	:	1649354291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHER GHATTAS D.C.

Provider Business Mailing Address
First Line	:	26223 W LAUREN DR
Second Line	:
City	:	CHANNAHON
State	:	IL
Zip	:	60410-5370
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 E ARMY TRAIL RD
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-1758
Country	:	US
Telephone Number	:	630-671-0555
Fax Number	:

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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