Provider Demographics
NPI:1164922332
Name:ESCHENBAUM, MATTHEW DALE (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DALE
Last Name:ESCHENBAUM
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 1:275 N YORK ST STE 301
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2784
Mailing Address - Country:US
Mailing Address - Phone:630-617-9790
Mailing Address - Fax:
Practice Address - Street 1:275 N YORK ST STE 301
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2784
Practice Address - Country:US
Practice Address - Phone:630-617-9790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor