Provider Demographics
NPI:1407154446
Name:KIRSCH, JODI HEATHER (DC)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:HEATHER
Last Name:KIRSCH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 N CARPENTER ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1713
Mailing Address - Country:US
Mailing Address - Phone:312-928-9282
Mailing Address - Fax:312-588-7211
Practice Address - Street 1:212 N CARPENTER ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1713
Practice Address - Country:US
Practice Address - Phone:312-928-9282
Practice Address - Fax:312-588-7211
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor