Healthcare Provider Details

I. General information

NPI: 1528677903
Provider Name (Legal Business Name): FOX RIVER CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1543 S RANDALL RD
ALGONQUIN IL
60102-5933
US

IV. Provider business mailing address

1543 S RANDALL RD
ALGONQUIN IL
60102-5933
US

V. Phone/Fax

Practice location:
  • Phone: 630-862-6356
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEVEN STACHURA
Title or Position: OWNER/CHIROPRACTOR
Credential:
Phone: 630-862-6356