Provider Demographics
NPI:1043266133
Name:MASSEY, SHERRY (DC)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:
Last Name:MASSEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 KINGERY HWY
Mailing Address - Street 2:SUITE 404
Mailing Address - City:WILLOW BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-2248
Mailing Address - Country:US
Mailing Address - Phone:630-789-3338
Mailing Address - Fax:630-789-3394
Practice Address - Street 1:6300 KINGERY HWY
Practice Address - Street 2:SUITE 404
Practice Address - City:WILLOW BROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-2248
Practice Address - Country:US
Practice Address - Phone:630-789-3338
Practice Address - Fax:630-789-3394
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009612111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK17695Medicare ID - Type Unspecified
ILK18910Medicare ID - Type Unspecified
ILV04516Medicare UPIN