Healthcare Provider Details

I. General information

NPI: 1366095739
Provider Name (Legal Business Name): ERICA JURIS DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6916 W KEENEY ST
NILES IL
60714-3005
US

IV. Provider business mailing address

6259 N CALDWELL AVE
CHICAGO IL
60646-4141
US

V. Phone/Fax

Practice location:
  • Phone: 224-587-0129
  • Fax:
Mailing address:
  • Phone: 224-587-0129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.013403
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: