Healthcare Provider Details

I. General information

NPI: 1225410368
Provider Name (Legal Business Name): ALLAN NANCE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13703 CICERO AVE
CRESTWOOD IL
60445-1824
US

IV. Provider business mailing address

13703 CICERO AVE
CRESTWOOD IL
60445-1824
US

V. Phone/Fax

Practice location:
  • Phone: 708-385-4416
  • Fax: 708-388-8825
Mailing address:
  • Phone: 708-385-4416
  • Fax: 708-388-8825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number52001977189N
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: