Provider Demographics
NPI:1528044278
Name:NELSON, JILL (DC)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:HOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1110 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-3247
Mailing Address - Country:US
Mailing Address - Phone:815-588-1110
Mailing Address - Fax:815-588-4025
Practice Address - Street 1:15222 S LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3711
Practice Address - Country:US
Practice Address - Phone:708-876-8207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1528044278OtherNPI
IL9921349OtherBCBS
IL364362224OtherFEIN
IL9921349OtherBCBS
IL364362224OtherFEIN