Provider Demographics
NPI:1558440347
Name:COHLER, ALICIA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:MARIE
Last Name:COHLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 W DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3808
Mailing Address - Country:US
Mailing Address - Phone:773-276-2801
Mailing Address - Fax:773-276-2803
Practice Address - Street 1:1630 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-3808
Practice Address - Country:US
Practice Address - Phone:773-276-2801
Practice Address - Fax:773-276-2803
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6152151OtherCIGNA PROVIDER ID NUMBER
IL7085576OtherAENTA PIN NUMBER
IL01632909OtherBLUE CROSS BLUE SHIELD ID
IL01632909OtherBLUE CROSS BLUE SHIELD ID
ILU94818Medicare UPIN