Provider Demographics
NPI:1588633580
Name:HYDE, RICHARD S (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:HYDE
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 1:416 E ROOSEVELT RD
Mailing Address - Street 2:#108
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5589
Mailing Address - Country:US
Mailing Address - Phone:630-665-0788
Mailing Address - Fax:630-665-0836
Practice Address - Street 1:416 E ROOSEVELT RD
Practice Address - Street 2:#108
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5589
Practice Address - Country:US
Practice Address - Phone:630-665-0788
Practice Address - Fax:630-665-0836
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002227038OtherBLUE CROSS BLUE SHIELD
ILK04309Medicare ID - Type Unspecified
IL0002227038OtherBLUE CROSS BLUE SHIELD