Healthcare Provider Details

I. General information

NPI: 1356572564
Provider Name (Legal Business Name): JOSH HOVER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8424 SKOKIE BLVD STE. 207
SKOKIE IL
60077-2568
US

IV. Provider business mailing address

8424 SKOKIE BLVD STE. 207
SKOKIE IL
60077-2568
US

V. Phone/Fax

Practice location:
  • Phone: 847-677-9355
  • Fax:
Mailing address:
  • Phone: 847-677-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number038-011357
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: