Provider Demographics
NPI:1770557134
Name:MAGHSOUDI, KAMBIZ TONY (DC)
Entity type:Individual
Prefix:DR
First Name:KAMBIZ
Middle Name:TONY
Last Name:MAGHSOUDI
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 1:1750 N WASHINGTON ST STE 112C
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-4850
Mailing Address - Country:US
Mailing Address - Phone:630-961-1888
Mailing Address - Fax:773-767-3944
Practice Address - Street 1:1750 N WASHINGTON ST STE 112C
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-4850
Practice Address - Country:US
Practice Address - Phone:630-961-1888
Practice Address - Fax:773-767-3944
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038008360OtherLICENSE #
IL038008360OtherLICENSE #