Provider Demographics
NPI:1053624411
Name:BANGURA, FATIMA SHIRLEY (BS, DC)
Entity type:Individual
Prefix:DR
First Name:FATIMA
Middle Name:SHIRLEY
Last Name:BANGURA
Suffix:
Gender:F
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 N. WINSLOWE DR.
Mailing Address - Street 2:APT. 3B
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074
Mailing Address - Country:US
Mailing Address - Phone:563-505-5344
Mailing Address - Fax:
Practice Address - Street 1:1565 N WINSLOWE DR
Practice Address - Street 2:APT. 3B
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-0120
Practice Address - Country:US
Practice Address - Phone:563-505-5344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011723111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor