MEDICARE: DR. TAHSEEN M MOINUDDIN 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	038009462	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710916242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAHSEEN M MOINUDDIN D.C

Provider Business Mailing 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	:

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	:	06/30/2006
Last Update Date	:	07/08/2007

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