Provider Demographics
NPI:1568691095
Name:VERCHOTA, ROBERT RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RYAN
Last Name:VERCHOTA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 S MICHIGAN AVE APT 214
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2956
Mailing Address - Country:US
Mailing Address - Phone:630-319-8183
Mailing Address - Fax:
Practice Address - Street 1:1600 S INDIANA AVE STE 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4733
Practice Address - Country:US
Practice Address - Phone:312-922-9868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011471111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor