Provider Demographics
NPI:1174033641
Name:DEMING, DWIGHT ANDERSON (DC)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:ANDERSON
Last Name:DEMING
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 1:12801 S WINNEBAGO RD
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2051
Mailing Address - Country:US
Mailing Address - Phone:708-361-7608
Mailing Address - Fax:
Practice Address - Street 1:555 PLAINFIELD RD STE C
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-7603
Practice Address - Country:US
Practice Address - Phone:630-887-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013142111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor