Provider Demographics
NPI:1407292550
Name:PORCHER, NATHAN JON (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:JON
Last Name:PORCHER
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 1:541 ROSE DR
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-2308
Mailing Address - Country:US
Mailing Address - Phone:847-873-2498
Mailing Address - Fax:
Practice Address - Street 1:541 ROSE DR
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-2308
Practice Address - Country:US
Practice Address - Phone:847-873-2498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012410111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor