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General NPI Number Information
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NPI Number | 1346649423
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Entity Type | Organization
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Legal Business Name | 41 NORTH CHIROPRACTIC & SOFT TISSUE CLINIC, P.C.
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Dates
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Enumeration Date | 08/14/2014
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Last Update Date | 08/14/2014
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Provider Practice Location Address
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Address Line | 1434 E MAIN ST SUITE A
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City | SAINT CHARLES
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State | IL
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Zip | 60174-2374
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Country | US
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Telephone | 630-450-5515
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Fax |
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Provider Business Mailing Address
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Address Line | 1434 E MAIN ST SUITE A
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City | SAINT CHARLES
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State | IL
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Zip | 60174-2374
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Country | US
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Telephone | 630-450-5515
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. ANITA ANN DICKERSON
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Credential | DC
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Telephone | 630-450-5515
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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 | 038010318
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License Number State | IL
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