Provider Demographics
NPI:1568664100
Name:BODYCARE CHIROPRACTIC OF OTTAWA S.C.
Entity Type:Organization
Organization Name:BODYCARE CHIROPRACTIC OF OTTAWA S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FLAHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-431-1350
Mailing Address - Street 1:643 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-2717
Mailing Address - Country:US
Mailing Address - Phone:815-431-1350
Mailing Address - Fax:815-431-1360
Practice Address - Street 1:643 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-2717
Practice Address - Country:US
Practice Address - Phone:815-431-1350
Practice Address - Fax:815-431-1360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042618790111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213499Medicare ID - Type Unspecified
ILU62261Medicare UPIN