=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215083530
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREFERRED CHIROPRACTIC CARE CENTER P C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2007
-----------------------------------------------------
Last Update Date | 06/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 109 1ST ST
-----------------------------------------------------
City | BLOOMINGDALE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60108-1219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-539-5822
-----------------------------------------------------
Fax | 630-539-5824
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6548
-----------------------------------------------------
City | BLOOMINGDALE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60108-6548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-539-5822
-----------------------------------------------------
Fax | 630-539-5824
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ALEX ZEVAN III
-----------------------------------------------------
Credential | DC, FIACA, DABCI
-----------------------------------------------------
Telephone | 630-539-5822
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NI0900X
-----------------------------------------------------
Taxonomy Name | Internist Chiropractor
-----------------------------------------------------
License Number | 038-007306
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------