Healthcare Provider Details

I. General information

NPI: 1003276346
Provider Name (Legal Business Name): DUPAGE HEALTHCARE ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROOSEVELT RD E-220
GLEN ELLYN IL
60137-5839
US

IV. Provider business mailing address

800 ROOSEVELT RD E-220
GLEN ELLYN IL
60137-5839
US

V. Phone/Fax

Practice location:
  • Phone: 630-730-6460
  • Fax: 801-751-6180
Mailing address:
  • Phone: 630-730-6460
  • Fax: 801-751-6180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: GREGORY T KUHLMAN
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 815-356-9371