Provider Demographics
NPI:1366626020
Name:DUCAT CHIROPRACTIC & WELLNESS CENTER, SC
Entity Type:Organization
Organization Name:DUCAT CHIROPRACTIC & WELLNESS CENTER, SC
Other - Org Name:DUCAT CHIROPRACTIC & SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUCAT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:224-653-8094
Mailing Address - Street 1:148 S BLOOMINGDALE RD
Mailing Address - Street 2:SUITE #107
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1492
Mailing Address - Country:US
Mailing Address - Phone:224-653-8094
Mailing Address - Fax:224-653-8317
Practice Address - Street 1:148 S BLOOMINGDALE RD
Practice Address - Street 2:SUITE #107
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1492
Practice Address - Country:US
Practice Address - Phone:224-653-8094
Practice Address - Fax:224-653-8317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
216040Medicare PIN