Healthcare Provider Details

I. General information

NPI: 1851674733
Provider Name (Legal Business Name): HOAD CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 N WATER ST
BATAVIA IL
60510-1986
US

IV. Provider business mailing address

34 N WATER ST
BATAVIA IL
60510-1986
US

V. Phone/Fax

Practice location:
  • Phone: 630-761-1314
  • Fax: 630-482-3093
Mailing address:
  • Phone: 630-761-1314
  • Fax: 630-482-3093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number038007837
License Number StateIL

VIII. Authorized Official

Name: MRS. LORI HOAD
Title or Position: OFFICE MANAGER
Credential:
Phone: 630-761-1314