Provider Demographics
NPI:1235472127
Name:CHAN, HARRIETT MAE HIDALGO (DC)
Entity Type:Individual
Prefix:DR
First Name:HARRIETT MAE
Middle Name:HIDALGO
Last Name:CHAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:HARRIETT MAE
Other - Middle Name:CHAN
Other - Last Name:SUMANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7363 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1230
Mailing Address - Country:US
Mailing Address - Phone:630-873-9841
Mailing Address - Fax:
Practice Address - Street 1:7363 NORTH AVE
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1230
Practice Address - Country:US
Practice Address - Phone:708-209-1155
Practice Address - Fax:708-209-1926
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor