Provider Demographics
NPI:1245398809
Name:JAMES P NOONAN DC SC
Entity Type:Organization
Organization Name:JAMES P NOONAN DC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:NOONAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-349-4580
Mailing Address - Street 1:14340 S LA GRANGE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2517
Mailing Address - Country:US
Mailing Address - Phone:708-349-4580
Mailing Address - Fax:708-349-4052
Practice Address - Street 1:14340 S LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462
Practice Address - Country:US
Practice Address - Phone:708-349-4580
Practice Address - Fax:708-349-4052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1682615OtherBCBS
T38279Medicare UPIN
IL208782Medicare ID - Type Unspecified
IL1682615OtherBCBS