Provider Demographics
NPI:1386338101
Name:AHMAD, ISAIAH W (DC)
Entity type:Individual
Prefix:DR
First Name:ISAIAH
Middle Name:W
Last Name:AHMAD
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 1:3488 SHADBLOW RD
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-8938
Mailing Address - Country:US
Mailing Address - Phone:909-843-0894
Mailing Address - Fax:
Practice Address - Street 1:718 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-2712
Practice Address - Country:US
Practice Address - Phone:909-986-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-07-18
Deactivation Date:2023-06-21
Deactivation Code:
Reactivation Date:2023-07-18
Provider Licenses
StateLicense IDTaxonomies
CADC36648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor