Provider Demographics
NPI:1467620716
Name:KEVIN J. REGAN, D.C,P.C.
Entity Type:Organization
Organization Name:KEVIN J. REGAN, D.C,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:REGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-876-1600
Mailing Address - Street 1:118 N CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2386
Mailing Address - Country:US
Mailing Address - Phone:312-876-1600
Mailing Address - Fax:312-876-1616
Practice Address - Street 1:118 N CLINTON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-2386
Practice Address - Country:US
Practice Address - Phone:312-876-1600
Practice Address - Fax:312-876-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038005108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3887091OtherCIGNA
IL1682322OtherBCBS
IL4580171OtherAETNA