Provider Demographics
NPI:1306854153
Name:ZUEHLKE, DALE ALLEN (DC)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:ALLEN
Last Name:ZUEHLKE
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 1:561 W DIVERSEY PKWY STE 221
Mailing Address - Street 2:GREATER CHICAGO CHIROPRACTIC
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1682
Mailing Address - Country:US
Mailing Address - Phone:773-871-7766
Mailing Address - Fax:773-871-0780
Practice Address - Street 1:561 W DIVERSEY PKWY STE 221
Practice Address - Street 2:GREATER CHICAGO CHIROPRACTIC
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1682
Practice Address - Country:US
Practice Address - Phone:773-871-7766
Practice Address - Fax:773-871-0780
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038005091111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04982061OtherBCBS
IL759260Medicare ID - Type Unspecified
T38636Medicare UPIN