Provider Demographics
NPI:1265448088
Name:DUPAGE CHIROPRACTIC CENTRE, LTD
Entity Type:Organization
Organization Name:DUPAGE CHIROPRACTIC CENTRE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEPPING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-858-9780
Mailing Address - Street 1:45 S PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6280
Mailing Address - Country:US
Mailing Address - Phone:630-858-9780
Mailing Address - Fax:630-858-9783
Practice Address - Street 1:45 S PARK BLVD
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6280
Practice Address - Country:US
Practice Address - Phone:630-858-9780
Practice Address - Fax:630-858-9783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02215218OtherBC/BS PROVIDER #
IL02215218OtherBC/BS PROVIDER #
IL534030Medicare ID - Type UnspecifiedMEDICARE PROVIDER #