Healthcare Provider Details

I. General information

NPI: 1871599266
Provider Name (Legal Business Name): JAMES A DEAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date: 12/22/2014
Reactivation Date: 12/30/2014

III. Provider practice location address

145 HIAWATHA DR
CAROL STREAM IL
60188-1774
US

IV. Provider business mailing address

145 HIAWATHA DR
CAROL STREAM IL
60188-1774
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-0003
  • Fax: 630-933-0001
Mailing address:
  • Phone: 630-933-0003
  • Fax: 630-933-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-004068
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: