Provider Demographics
NPI:1629400759
Name:HINSDALE EXPERIENCE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:HINSDALE EXPERIENCE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:WARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-841-0096
Mailing Address - Street 1:3000 WOODCREEK DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-5401
Mailing Address - Country:US
Mailing Address - Phone:312-841-0096
Mailing Address - Fax:
Practice Address - Street 1:3000 WOODCREEK DR
Practice Address - Street 2:SUITE 120
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5401
Practice Address - Country:US
Practice Address - Phone:312-841-0096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty