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NPI Code Detail

MEDICARE: HALI DETERS DC

MEDICARE: HALI DETERS DC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111NR0400XRehabilitation Chiropractor038014324IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CH-60984042OTHERWACHIROPRACTIC LICENSE

General Provider Information

NPI Number : 1225687924
Entity Type Code : Individual
Provider Name (Legal Business Name) : HALI DETERS DC
Provider Business Mailing Address
First Line : 3620 N LINCOLN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60613-3516
Country : US
Telephone Number : 872-239-4425
Fax Number :
Provider Business Practice Location Address
First Line : 3620 N LINCOLN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60613-3516
Country : US
Telephone Number : 872-239-4425
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2019
Last Update Date : 03/19/2026

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Directions to “ HALI DETERS DC” Practice Location

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