Provider Demographics
NPI:1336293968
Name:THEA C. FLOCK, D.C., S.C.
Entity Type:Organization
Organization Name:THEA C. FLOCK, D.C., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEA
Authorized Official - Middle Name:C
Authorized Official - Last Name:FLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-771-9662
Mailing Address - Street 1:440 QUADRANGLE DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-3454
Mailing Address - Country:US
Mailing Address - Phone:630-771-9662
Mailing Address - Fax:630-771-9663
Practice Address - Street 1:440 QUADRANGLE DR
Practice Address - Street 2:SUITE E
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-3454
Practice Address - Country:US
Practice Address - Phone:630-771-9662
Practice Address - Fax:630-771-9663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042.618103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
09932027OtherBCBS PROVIDER #
U67739Medicare UPIN
205549Medicare PIN
P00144113Medicare PIN