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General NPI Number Information
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NPI Number | 1447591367
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Entity Type | Organization
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Legal Business Name | ADVANCED CHIROPRACTIC CLINIC, INC.
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Dates
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Enumeration Date | 03/04/2013
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Last Update Date | 03/04/2013
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Provider Practice Location Address
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Address Line | 953 N LIBERTY ST
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City | ELGIN
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State | IL
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Zip | 60120-3061
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Country | US
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Telephone | 847-695-0220
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Fax |
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Provider Business Mailing Address
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Address Line | 953 N LIBERTY ST
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City | ELGIN
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State | IL
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Zip | 60120-3061
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Country | US
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Telephone | 847-695-0220
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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. DAN T NOERENBERG
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Credential | DC
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Telephone | 847-695-0220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | 038006220
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License Number State | IL
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