Provider Demographics
NPI:1285717165
Name:KHORSHID, KHALED A (DC)
Entity type:Individual
Prefix:DR
First Name:KHALED
Middle Name:A
Last Name:KHORSHID
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 1:9004 RIDGELAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-1414
Mailing Address - Country:US
Mailing Address - Phone:708-288-2239
Mailing Address - Fax:708-233-6167
Practice Address - Street 1:9830 RIDGELAND AVE
Practice Address - Street 2:CHICAG RIDGE MEDICAL CENTER - SUITE 5
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-2667
Practice Address - Country:US
Practice Address - Phone:708-288-2239
Practice Address - Fax:708-233-6167
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008190111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633049OtherBC/BS
ILK08024OtherMEDICARE PROVIDER MEMBER NUMBER
IL647758OtherAMERICAN CHIROPRACTIC ACN
ILU71814Medicare UPIN
IL647758OtherAMERICAN CHIROPRACTIC ACN