Provider Demographics
NPI:1144425489
Name:ATKINSON, JUSTIN E (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:E
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 COMMERCE DR
Mailing Address - Street 2:#108
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-7807
Mailing Address - Country:US
Mailing Address - Phone:847-223-3158
Mailing Address - Fax:888-481-4758
Practice Address - Street 1:15 COMMERCE DR
Practice Address - Street 2:#108
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-7807
Practice Address - Country:US
Practice Address - Phone:847-223-3158
Practice Address - Fax:888-481-4758
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011481111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC808996Medicare PIN