Provider Demographics
NPI:1225077555
Name:HALL, JERIJO MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:JERIJO
Middle Name:MARIE
Last Name:HALL
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 1:2625 BUTTERFIELD RD
Mailing Address - Street 2:SUITE 301N
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1234
Mailing Address - Country:US
Mailing Address - Phone:630-320-6400
Mailing Address - Fax:630-701-1007
Practice Address - Street 1:2728 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2164
Practice Address - Country:US
Practice Address - Phone:262-303-4252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010283111N00000X
WI5433-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1635113OtherBLUE CROSS ID #
IL211550OtherOLD MEDICARE PIN
ILK32013OtherNEW MEDICARE #
IL214291OtherNEW MEDICARE PIN
ILK17158OtherOLD MEDICARE #
IL211550OtherOLD MEDICARE PIN