Provider Demographics
NPI:1255300232
Name:RICHARD S. HYDE, SC
Entity Type:Organization
Organization Name:RICHARD S. HYDE, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:HYDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-665-0788
Mailing Address - Street 1:416 E ROOSEVELT RD
Mailing Address - Street 2:#108
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5589
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:416 E ROOSEVELT RD
Practice Address - Street 2:#108
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5589
Practice Address - Country:US
Practice Address - Phone:630-665-0788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002227038OtherBLUE CROSS BLUE SHIELD
IL0002227038OtherBLUE CROSS BLUE SHIELD
U82520Medicare UPIN