Provider Demographics
NPI:1518971902
Name:HUYVAERT, THOMAS DANIEL (DC LAC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DANIEL
Last Name:HUYVAERT
Suffix:
Gender:M
Credentials:DC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-3506
Mailing Address - Country:US
Mailing Address - Phone:630-790-0030
Mailing Address - Fax:630-790-2086
Practice Address - Street 1:1142 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-3506
Practice Address - Country:US
Practice Address - Phone:630-790-0030
Practice Address - Fax:630-790-2086
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038004730111N00000X
IL198000187171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
02215409OtherBCBS
IL697790Medicare ID - Type Unspecified