Provider Demographics
NPI:1205011590
Name:NAPERVILLE FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:NAPERVILLE FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-718-1700
Mailing Address - Street 1:808 RICKERT DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-0905
Mailing Address - Country:US
Mailing Address - Phone:630-718-1700
Mailing Address - Fax:630-718-1697
Practice Address - Street 1:808 RICKERT DR
Practice Address - Street 2:SUITE 101
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-0905
Practice Address - Country:US
Practice Address - Phone:630-718-1700
Practice Address - Fax:630-718-1697
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAPERVILLE FAMILY CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2223339OtherBLUE CROSS AND BLUE SHIEL
112030585991OtherHUMANA