Provider Demographics
NPI:1346303146
Name:KIRCHNER-GOMEZ, ALLAN (DC)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:
Last Name:KIRCHNER-GOMEZ
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 1:798 W ARMY TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-9297
Mailing Address - Country:US
Mailing Address - Phone:630-233-8343
Mailing Address - Fax:630-233-8346
Practice Address - Street 1:798 W ARMY TRAIL RD
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-9297
Practice Address - Country:US
Practice Address - Phone:630-233-8343
Practice Address - Fax:630-233-8346
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009776111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038009776Medicaid
ILU93210Medicare UPIN
IL212251Medicare ID - Type Unspecified