Provider Demographics
NPI:1487838363
Name:KEZON CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:KEZON CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:KEZON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:708-429-6061
Mailing Address - Street 1:6700 W. 167TH ST. STE. 2
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2859
Mailing Address - Country:US
Mailing Address - Phone:708-429-6061
Mailing Address - Fax:708-429-6092
Practice Address - Street 1:6700 W. 167TH ST. STE. 2
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2859
Practice Address - Country:US
Practice Address - Phone:708-429-6061
Practice Address - Fax:708-429-6092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty