Provider Demographics
NPI:1194338640
Name:ALQAZAHA, ELIAS G (DC)
Entity type:Individual
Prefix:
First Name:ELIAS
Middle Name:G
Last Name:ALQAZAHA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 SHADY BROOK LN
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-3009
Mailing Address - Country:US
Mailing Address - Phone:810-459-1595
Mailing Address - Fax:
Practice Address - Street 1:8170 SHADY BROOK LN
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-3009
Practice Address - Country:US
Practice Address - Phone:810-459-1595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501011856225700000X
MI2301401558111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist