Healthcare Provider Details

I. General information

NPI: 1306854153
Provider Name (Legal Business Name): DALE ALLEN ZUEHLKE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 W DIVERSEY PKWY STE 221 GREATER CHICAGO CHIROPRACTIC
CHICAGO IL
60614-1682
US

IV. Provider business mailing address

561 W DIVERSEY PKWY STE 221 GREATER CHICAGO CHIROPRACTIC
CHICAGO IL
60614-1682
US

V. Phone/Fax

Practice location:
  • Phone: 773-871-7766
  • Fax: 773-871-0780
Mailing address:
  • Phone: 773-871-7766
  • Fax: 773-871-0780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038005091
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: