Basic Information
Provider Information | |||||||||
NPI: | 1568731081 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ALEBIOSU | ||||||||
FirstName: | RAQAQ | ||||||||
MiddleName: | ADEREMI | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: | JR. | ||||||||
Credential: | DC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ALEBIOSU | ||||||||
OtherFirstName: | RAQAQ | ||||||||
OtherMiddleName: | ADEREMI | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: | JR. | ||||||||
OtherCredential: | DC | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 3100 DUNDEE RD STE 506 | ||||||||
Address2: |   | ||||||||
City: | NORTHBROOK | ||||||||
State: | IL | ||||||||
PostalCode: | 600622449 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: |   | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 3100 DUNDEE RD STE 506 | ||||||||
Address2: |   | ||||||||
City: | NORTHBROOK | ||||||||
State: | IL | ||||||||
PostalCode: | 600622449 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8475620840 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/29/2011 | ||||||||
LastUpdateDate: | 12/29/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 038.012099 | IL | Y |   | Chiropractic Providers | Chiropractor |   |
No ID Information.