Healthcare Provider Details

I. General information

NPI: 1063685246
Provider Name (Legal Business Name): THOMAS BURTON SPERRY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2585 OGDEN AVE
DOWNERS GROVE IL
60515-1708
US

IV. Provider business mailing address

2585 OGDEN AVE
DOWNERS GROVE IL
60515-1708
US

V. Phone/Fax

Practice location:
  • Phone: 630-729-7024
  • Fax: 630-963-4420
Mailing address:
  • Phone: 630-729-7024
  • Fax: 630-963-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number038005498
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number038-005498
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number038-005498
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number038-005498
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: