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General NPI Number Information
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NPI Number | 1134201668
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Entity Type | Organization
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Legal Business Name | EXPERIENCE CHIROPRACTIC
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 09/22/2009
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Provider Practice Location Address
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Address Line | 1971 N FREMONT ST SUITE 3
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City | CHICAGO
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State | IL
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Zip | 60614-3591
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Country | US
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Telephone | 480-313-8862
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Fax | 773-409-5706
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Provider Business Mailing Address
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Address Line | 1971 N FREMONT ST SUITE 3
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City | CHICAGO
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State | IL
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Zip | 60614-3591
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Country | US
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Telephone | 480-313-8862
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Fax | 773-409-5706
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. DAVID DOUGLAS WARMAN
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Credential | D.C.
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Telephone | 480-313-8862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038011363
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License Number State | IL
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