Provider Demographics
NPI:1659404630
Name:FRONTIER CHIROPRACITC AND IMAGING CENTER LTD.
Entity Type:Organization
Organization Name:FRONTIER CHIROPRACITC AND IMAGING CENTER LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:WEINFURTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-344-2700
Mailing Address - Street 1:3737 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-4372
Mailing Address - Country:US
Mailing Address - Phone:815-344-2700
Mailing Address - Fax:815-344-2727
Practice Address - Street 1:3729 W ELM ST
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4372
Practice Address - Country:US
Practice Address - Phone:815-344-2700
Practice Address - Fax:815-344-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009889111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL97416Medicare ID - Type Unspecified
ILU94421Medicare UPIN