Healthcare Provider Details

I. General information

NPI: 1962725002
Provider Name (Legal Business Name): STEPHEN ARLIE HOLCOMB DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 SKOKIE BLVD
NORTHBROOK IL
60062-1607
US

IV. Provider business mailing address

PO BOX 5998 DEPT 20-5032
CAROL STREAM IL
60197-5998
US

V. Phone/Fax

Practice location:
  • Phone: 224-636-5065
  • Fax: 224-635-5068
Mailing address:
  • Phone: 630-754-8788
  • Fax: 630-468-1824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038011580
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: