Provider Demographics
NPI:1306909163
Name:AHMAD, AMINA JABEEN (DC)
Entity type:Individual
Prefix:DR
First Name:AMINA
Middle Name:JABEEN
Last Name:AHMAD
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 1:4007 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2819
Mailing Address - Country:US
Mailing Address - Phone:773-794-1111
Mailing Address - Fax:773-481-5830
Practice Address - Street 1:6767 W GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214
Practice Address - Country:US
Practice Address - Phone:414-448-7022
Practice Address - Fax:773-481-5830
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009243111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632435OtherBLUE CROSS PROVIDER ID #