Provider Demographics
NPI:1235280058
Name:CYRUS, ALAN DOUGLAS (DC)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:DOUGLAS
Last Name:CYRUS
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 1:2647 E 200 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:PANA
Mailing Address - State:IL
Mailing Address - Zip Code:62557-6641
Mailing Address - Country:US
Mailing Address - Phone:217-562-3818
Mailing Address - Fax:
Practice Address - Street 1:103 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PANA
Practice Address - State:IL
Practice Address - Zip Code:62557-1144
Practice Address - Country:US
Practice Address - Phone:217-562-9241
Practice Address - Fax:217-562-9241
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-004467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371134811OtherFEDERAL EIN
IL696090Medicare ID - Type Unspecified
IL371134811OtherFEDERAL EIN