Provider Demographics
NPI:1215013800
Name:EGLY, KIMBERLY M (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:M
Last Name:EGLY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 N STATE ST STE 310
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2781
Mailing Address - Country:US
Mailing Address - Phone:312-988-9655
Mailing Address - Fax:312-988-7060
Practice Address - Street 1:1150 N STATE ST STE 310
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-2781
Practice Address - Country:US
Practice Address - Phone:312-988-9655
Practice Address - Fax:312-988-7060
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1682319OtherBLUE CROSS BLUE SHIELD
ILT87147Medicare UPIN
IL909700Medicare ID - Type Unspecified