Healthcare Provider Details

I. General information

NPI: 1639394943
Provider Name (Legal Business Name): MAIN STREET CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23915 W MAIN ST SUITE D
PLAINFIELD IL
60544-1967
US

IV. Provider business mailing address

23915 W MAIN ST SUITE D
PLAINFIELD IL
60544-1967
US

V. Phone/Fax

Practice location:
  • Phone: 815-230-9070
  • Fax: 815-230-9334
Mailing address:
  • Phone: 815-230-9070
  • Fax: 815-230-9334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

# 1
Identifier9932028
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBLUE CROSS BLUE SHIELD

VIII. Authorized Official

Name: DR. SCOTT DAVID STUCK
Title or Position: OWNER
Credential: D.C.
Phone: 815-230-9070