Healthcare Provider Details

I. General information

NPI: 1922261072
Provider Name (Legal Business Name): GENTLE HANDS CHIROPRACTIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W KENNEDY RD
BRAIDWOOD IL
60408-1931
US

IV. Provider business mailing address

140 E 1ST ST
BRAIDWOOD IL
60408-1703
US

V. Phone/Fax

Practice location:
  • Phone: 815-458-2225
  • Fax: 866-272-7518
Mailing address:
  • Phone: 815-458-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038011199
License Number StateIL

VIII. Authorized Official

Name: DR. JOHN HUGH BRAITHWAITE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 815-458-2225