Provider Demographics
NPI:1609897826
Name:SPECKMAN, JODINE A (DC)
Entity Type:Individual
Prefix:
First Name:JODINE
Middle Name:A
Last Name:SPECKMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1211 W JARVIS AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-7057
Mailing Address - Country:US
Mailing Address - Phone:773-281-3341
Mailing Address - Fax:773-281-3373
Practice Address - Street 1:3354 N PAULINA ST
Practice Address - Street 2:SUITE 203
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1068
Practice Address - Country:US
Practice Address - Phone:773-281-3341
Practice Address - Fax:773-281-3373
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL038006985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK31079Medicare PIN