Healthcare Provider Details

I. General information

NPI: 1003933300
Provider Name (Legal Business Name): WEBER MICETICH CHIROPRACTIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 E NORTH ST
COAL CITY IL
60416-1087
US

IV. Provider business mailing address

24 E NORTH ST
COAL CITY IL
60416-1087
US

V. Phone/Fax

Practice location:
  • Phone: 815-634-0445
  • Fax: 815-634-3188
Mailing address:
  • Phone: 815-634-0445
  • Fax: 815-634-3188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038007825
License Number StateIL

VIII. Authorized Official

Name: DR. JULI WEBER-MICETICH
Title or Position: OWNER
Credential: DC
Phone: 815-634-0445