Healthcare Provider Details

I. General information

NPI: 1578880084
Provider Name (Legal Business Name): NORTHERN MCHENRY CHIROPRACTIC, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 W JOHNSBURG RD
JOHNSBURG IL
60051-5105
US

IV. Provider business mailing address

2604 W JOHNSBURG RD
JOHNSBURG IL
60051-5105
US

V. Phone/Fax

Practice location:
  • Phone: 815-578-1771
  • Fax:
Mailing address:
  • Phone: 815-578-1771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.0009638
License Number StateIL

VIII. Authorized Official

Name: JULIE CALHOUN
Title or Position: OFFICE MANAGER
Credential:
Phone: 815-578-1771