Provider Demographics
NPI:1407965114
Name:EHLERS, LINDA LUCIENNE (DC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LUCIENNE
Last Name:EHLERS
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 1:10413 S ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1931
Mailing Address - Country:US
Mailing Address - Phone:708-598-9010
Mailing Address - Fax:708-390-3482
Practice Address - Street 1:10413 S ROBERTS RD
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1931
Practice Address - Country:US
Practice Address - Phone:708-598-9010
Practice Address - Fax:708-390-1931
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038004667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0071641033OtherBLUECROSS
IL0071641033OtherBLUECROSS
ILK11889Medicare ID - Type Unspecified