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General NPI Number Information
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NPI Number | 1700132891
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Entity Type | Organization
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Legal Business Name | BARTLETT CHIROPRACTIC CLINIC, S.C.
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Dates
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Enumeration Date | 07/26/2012
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Last Update Date | 07/26/2012
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Provider Practice Location Address
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Address Line | 138 S OAK AVE
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City | BARTLETT
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State | IL
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Zip | 60103-6620
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Country | US
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Telephone | 630-830-1500
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Fax | 630-830-2513
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Provider Business Mailing Address
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Address Line | 138 S OAK AVE
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City | BARTLETT
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State | IL
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Zip | 60103-6620
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Country | US
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Telephone | 630-830-1500
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Fax | 630-830-2513
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KEITH CHARLES RICHARD
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Credential | DC
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Telephone | 630-830-1500
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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 | 038010561
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License Number State | IL
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