Healthcare Provider Details

I. General information

NPI: 1497480313
Provider Name (Legal Business Name): ADAM JACOB ALCANTAR DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2022
Last Update Date: 07/24/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24020 W RIVERWALK CT STE 118
PLAINFIELD IL
60544-7123
US

IV. Provider business mailing address

6460 DOUBLE EAGLE DR UNIT 312
WOODRIDGE IL
60517-1681
US

V. Phone/Fax

Practice location:
  • Phone: 815-782-7097
  • Fax:
Mailing address:
  • Phone: 630-863-3959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.013874
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: