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General NPI Number Information
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NPI Number | 1548334287
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Entity Type | Organization
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Legal Business Name | BOURBONNAIS CHIROPRACTIC LTD
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 04/20/2011
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Provider Practice Location Address
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Address Line | 201 PARK PL STE 10
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City | BOURBONNAIS
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State | IL
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Zip | 60914-1883
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Country | US
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Telephone | 815-939-2225
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Fax | 815-939-8993
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Provider Business Mailing Address
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Address Line | 201 PARK PL STE 10
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City | BOURBONNAIS
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State | IL
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Zip | 60914-1883
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Country | US
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Telephone | 815-939-2225
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Fax | 815-939-8993
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES R TRIPP
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Credential | DC
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Telephone | 815-939-2225
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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 | 038006693
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License Number State | IL
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