Provider Demographics
NPI:1366777815
Name:ANSARI, AHMAD ADIL (DC)
Entity type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:ADIL
Last Name:ANSARI
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 1:13109 BUSTLETON AVE
Mailing Address - Street 2:APT C-20
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-1647
Mailing Address - Country:US
Mailing Address - Phone:248-703-3342
Mailing Address - Fax:
Practice Address - Street 1:4607 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-1217
Practice Address - Country:US
Practice Address - Phone:215-329-6136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009719111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor