Individual provider Active NPI

Khalaf H Khalifeh, D.C

  • Chiropractor
  • Berwyn, IL
National Provider Identifier
1992101844
Registry record updated Jan 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038.012693 Issued in IL
Practice address
6905 Cermak Rd
Ste B
Berwyn, IL 60402-2175
Phone
(708) 691-7406
Fax
(844) 273-9797
NPI assigned
Nov 4, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038.012693 IL Primary
Rehabilitation Chiropractor 111NR0400X 038.012693 IL

Addresses

Primary practice location

6905 Cermak Rd
Ste B
Berwyn, IL 60402-2175

Mailing address

6905 Cermak Rd
Ste B
Berwyn, IL 60402-2175
Phone (708) 691-7406

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038.012693ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Excellence Chiropractic, LLC Chiropractor CurrentSince Dec 22, 2020 Accepting new patients
Santos Natural Health Center,LTD Chiropractor Past Accepting new patients

Locations

6538 Cermak Rd
Unit 5
Berwyn, IL 60402
Phone (708) 317-5131

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1415059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452470400000",
    "number": "1992101844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6905 CERMAK RD",
            "address_2": "STE B",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604022175",
            "telephone_number": "708-691-7406",
            "fax_number": "844-273-9797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6905 CERMAK RD",
            "address_2": "STE B",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604022175",
            "telephone_number": "708-691-7406",
            "fax_number": "844-273-9797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHALIFEH",
        "first_name": "KHALAF",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "D.C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-11-04",
        "last_updated": "2016-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038.012693",
            "primary": true
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "IL",
            "license": "038.012693",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berwyn, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.