Healthcare Provider Details

I. General information

NPI: 1275539942
Provider Name (Legal Business Name): JOEL A CHINNICI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 W BOUGHTON RD
BOLINGBROOK IL
60440-1872
US

IV. Provider business mailing address

402 W BOUGHTON RD
BOLINGBROOK IL
60440-1872
US

V. Phone/Fax

Practice location:
  • Phone: 630-759-7799
  • Fax: 630-759-8995
Mailing address:
  • Phone: 630-759-7799
  • Fax: 630-759-8995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38003814
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: