Provider Demographics
NPI:1629111000
Name:DAVID G LIFKA DC PC
Entity Type:Organization
Organization Name:DAVID G LIFKA DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:LIFKA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-898-0101
Mailing Address - Street 1:1660 N FARNSWORTH AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-1892
Mailing Address - Country:US
Mailing Address - Phone:630-898-0101
Mailing Address - Fax:
Practice Address - Street 1:1660 N FARNSWORTH AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-1892
Practice Address - Country:US
Practice Address - Phone:630-898-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007320111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4504888OtherBC-BS PROVIDER ID
ILU44107Medicare UPIN
IL4504888OtherBC-BS PROVIDER ID