Provider Demographics
NPI:1497480313
Name:ALCANTAR, ADAM JACOB (DC)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:JACOB
Last Name:ALCANTAR
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 1:6460 DOUBLE EAGLE DR UNIT 312
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1681
Mailing Address - Country:US
Mailing Address - Phone:630-863-3959
Mailing Address - Fax:
Practice Address - Street 1:24020 W RIVERWALK CT STE 118
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-7123
Practice Address - Country:US
Practice Address - Phone:815-782-7097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-24
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor