Provider Demographics
NPI:1285908566
Name:HUSSAIN, ALIA (DC)
Entity type:Individual
Prefix:
First Name:ALIA
Middle Name:
Last Name:HUSSAIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-3958
Mailing Address - Country:US
Mailing Address - Phone:715-848-2526
Mailing Address - Fax:715-848-2225
Practice Address - Street 1:3540 STEWART AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4919
Practice Address - Country:US
Practice Address - Phone:715-842-3999
Practice Address - Fax:715-843-7761
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-03
Last Update Date:2012-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4852-12111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition