Provider Demographics
NPI:1447315148
Name:KARKACHE, KHALID (DC)
Entity type:Individual
Prefix:DR
First Name:KHALID
Middle Name:
Last Name:KARKACHE
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 1:7 CLIFTON ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-3127
Mailing Address - Country:US
Mailing Address - Phone:978-447-1999
Mailing Address - Fax:617-398-9962
Practice Address - Street 1:469 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3602
Practice Address - Country:US
Practice Address - Phone:617-389-9919
Practice Address - Fax:617-389-9962
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH 2390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA36684OtherBLUE CROSS BLUE SHIELD
MA1202096OtherUNITED HEALTH CARE
MA1696891Medicaid
MA2518041OtherAETNA HEALTH CARE
MA1202096OtherUNITED HEALTH CARE