Provider Demographics
NPI:1396419552
Name:SIERRA, ELIUD MIGUEL JR (DC)
Entity Type:Individual
Prefix:
First Name:ELIUD
Middle Name:MIGUEL
Last Name:SIERRA
Suffix:JR
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 1:345 SHAWNEE DR
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-1966
Mailing Address - Country:US
Mailing Address - Phone:630-877-7389
Mailing Address - Fax:
Practice Address - Street 1:148 S BLOOMINGDALE RD STE 107C
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1491
Practice Address - Country:US
Practice Address - Phone:630-877-7389
Practice Address - Fax:630-982-1278
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor