Provider Demographics
NPI:1154816775
Name:GARRETT EZELL DC PC
Entity Type:Organization
Organization Name:GARRETT EZELL DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:PRESTON
Authorized Official - Last Name:EZELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-451-2707
Mailing Address - Street 1:6101 W WARWICK AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-2557
Mailing Address - Country:US
Mailing Address - Phone:312-451-2707
Mailing Address - Fax:
Practice Address - Street 1:7323 NORTHGATE WAY UNIT 9
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-4058
Practice Address - Country:US
Practice Address - Phone:312-451-2707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty