Healthcare Provider Details

I. General information

NPI: 1841967817
Provider Name (Legal Business Name): GRACE HACH DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 N KIRK RD STE 103
GENEVA IL
60134-1667
US

IV. Provider business mailing address

429 N KIRK RD STE 103
GENEVA IL
60134-1667
US

V. Phone/Fax

Practice location:
  • Phone: 630-605-6323
  • Fax: 877-511-8780
Mailing address:
  • Phone: 630-605-6323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038013760
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: