Provider Demographics
NPI:1154448546
Name:SCALLEY, MICHAEL JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:SCALLEY
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 1:333 E ARNOLD ST
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-1108
Mailing Address - Country:US
Mailing Address - Phone:815-353-5741
Mailing Address - Fax:
Practice Address - Street 1:335 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:HINCKLEY
Practice Address - State:IL
Practice Address - Zip Code:60520-9775
Practice Address - Country:US
Practice Address - Phone:815-283-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007088111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1982022OtherBCBS PROVIDER NUMBER
IL323060Medicare PIN