Provider Demographics
NPI:1346649423
Name:41 NORTH CHIROPRACTIC & SOFT TISSUE CLINIC, P.C.
Entity Type:Organization
Organization Name:41 NORTH CHIROPRACTIC & SOFT TISSUE CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-450-5515
Mailing Address - Street 1:1434 E MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2374
Mailing Address - Country:US
Mailing Address - Phone:630-450-5515
Mailing Address - Fax:
Practice Address - Street 1:1434 E MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2374
Practice Address - Country:US
Practice Address - Phone:630-450-5515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010318111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty