=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962875336
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TILSON CHIROPRACTIC FAMILYCARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2015
-----------------------------------------------------
Last Update Date | 01/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2112 WINDING RIVER DR STE 120
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60564-8554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-428-2299
-----------------------------------------------------
Fax | 224-330-1920
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2112 WINDING RIVER DR STE 120
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60564-8554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-428-2299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CO-OWNER
-----------------------------------------------------
Name | DR. ADAM TILSON
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 630-428-2299
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | 038.011200
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------