Provider Demographics
NPI:1558568089
Name:DR. STEVEN HETTINGER
Entity Type:Organization
Organization Name:DR. STEVEN HETTINGER
Other - Org Name:WOODRIDGE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HETTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-963-1212
Mailing Address - Street 1:7409 WOODRIDGE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-2249
Mailing Address - Country:US
Mailing Address - Phone:630-963-1212
Mailing Address - Fax:630-963-1594
Practice Address - Street 1:7409 WOODRIDGE DR
Practice Address - Street 2:SUITE C
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2249
Practice Address - Country:US
Practice Address - Phone:630-963-1212
Practice Address - Fax:630-963-1594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009186111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209014Medicare UPIN
IL209014Medicare ID - Type Unspecified
ILU99842Medicare UPIN