Healthcare Provider Details

I. General information

NPI: 1366646135
Provider Name (Legal Business Name): CHERNE CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 W ALGONQUIN RD
ALGONQUIN IL
60102-3577
US

IV. Provider business mailing address

1115 W ALGONQUIN RD
ALGONQUIN IL
60102-3577
US

V. Phone/Fax

Practice location:
  • Phone: 847-854-4889
  • Fax:
Mailing address:
  • Phone: 847-854-4889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: GRETCHEN GRAHAM CHERNE
Title or Position: ORGANIZER
Credential: D.C.
Phone: 815-991-5191