=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578880084
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHERN MCHENRY CHIROPRACTIC, LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2010
-----------------------------------------------------
Last Update Date | 05/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2604 W JOHNSBURG RD
-----------------------------------------------------
City | JOHNSBURG
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60051-5105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-578-1771
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2604 W JOHNSBURG RD
-----------------------------------------------------
City | JOHNSBURG
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60051-5105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-578-1771
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | JULIE CALHOUN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 815-578-1771
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 038.0009638
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------