Healthcare Provider Details

I. General information

NPI: 1417278854
Provider Name (Legal Business Name): MVP CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N VINE ST UNIT 101
NEW LENOX IL
60451-1652
US

IV. Provider business mailing address

305 N VINE ST UNIT 101
NEW LENOX IL
60451-1652
US

V. Phone/Fax

Practice location:
  • Phone: 815-717-6483
  • Fax: 312-253-1419
Mailing address:
  • Phone: 815-717-6483
  • Fax: 312-253-1419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL L VEERMAN
Title or Position: OWNER
Credential: D.C.
Phone: 815-549-6341