Provider Demographics
NPI:1043372832
Name:KHAIRALLAH, RAIMAND F (DC)
Entity type:Individual
Prefix:DR
First Name:RAIMAND
Middle Name:F
Last Name:KHAIRALLAH
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 1:4501 N STERLING AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-3834
Mailing Address - Country:US
Mailing Address - Phone:309-679-9575
Mailing Address - Fax:309-679-9581
Practice Address - Street 1:63 ANDERSON AVE STE A
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1537
Practice Address - Country:US
Practice Address - Phone:508-947-1411
Practice Address - Fax:508-946-4413
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010045111N00000X
MACH 2766111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36936OtherBLUE CROSS BLUE SHIELD
MAKH Y45578Medicare ID - Type UnspecifiedPROVIDER ID#
MAY36936OtherBLUE CROSS BLUE SHIELD
MAU93187Medicare UPIN