Provider Demographics
NPI:1619174745
Name:DALAN, MICHAEL JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAY
Last Name:DALAN
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 1:1813 N MILL ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1289
Mailing Address - Country:US
Mailing Address - Phone:630-527-8855
Mailing Address - Fax:630-527-9159
Practice Address - Street 1:1813 N MILL ST
Practice Address - Street 2:SUITE E
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1289
Practice Address - Country:US
Practice Address - Phone:630-527-8855
Practice Address - Fax:630-527-9159
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-006431111N00000X
WACH00002423111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2205260OtherBLUECROSS BLUESHIELD
U89088Medicare UPIN
IL201417Medicare ID - Type Unspecified