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General NPI Number Information
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NPI Number | 1770950289
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Entity Type | Organization
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Legal Business Name | ADIO CHIROPRACTIC CLINIC SC
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Dates
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Enumeration Date | 09/01/2015
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Last Update Date | 09/01/2015
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Provider Practice Location Address
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Address Line | 33197 N SEARS BLVD
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City | GRAYSLAKE
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State | IL
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Zip | 60030-2177
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Country | US
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Telephone | 847-816-3350
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Fax |
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Provider Business Mailing Address
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Address Line | 316 PETERSON RD
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-1008
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Country | US
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Telephone | 847-816-3350
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DANNY MCLANE
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Credential | D. C
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Telephone | 847-816-3350
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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 | 038012094
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License Number State | IL
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