Provider Demographics
NPI:1649417593
Name:CHIROPRACTIC ASSOCIATES OF KANKAKEE INC
Entity Type:Organization
Organization Name:CHIROPRACTIC ASSOCIATES OF KANKAKEE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-468-7787
Mailing Address - Street 1:53 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANTENO
Mailing Address - State:IL
Mailing Address - Zip Code:60950-1534
Mailing Address - Country:US
Mailing Address - Phone:815-468-7787
Mailing Address - Fax:815-468-0154
Practice Address - Street 1:53 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANTENO
Practice Address - State:IL
Practice Address - Zip Code:60950-1534
Practice Address - Country:US
Practice Address - Phone:815-468-7787
Practice Address - Fax:815-468-0154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010846261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center