Provider Demographics
NPI:1508053422
Name:KLINE, DAVID CARL (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CARL
Last Name:KLINE
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 1:956 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915-2011
Mailing Address - Country:US
Mailing Address - Phone:815-933-2246
Mailing Address - Fax:815-933-2246
Practice Address - Street 1:956 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-2011
Practice Address - Country:US
Practice Address - Phone:815-933-2246
Practice Address - Fax:815-933-2246
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007032111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN337020Medicare PIN
ILT96971Medicare UPIN