Provider Demographics
NPI:1679864763
Name:KLEIN, GARRETT ADAM (DC)
Entity Type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:ADAM
Last Name:KLEIN
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 1:157 E NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60164-2523
Mailing Address - Country:US
Mailing Address - Phone:708-562-9980
Mailing Address - Fax:708-562-9983
Practice Address - Street 1:157 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:NORTHLAKE
Practice Address - State:IL
Practice Address - Zip Code:60164-2523
Practice Address - Country:US
Practice Address - Phone:708-562-9980
Practice Address - Fax:708-562-9983
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011642111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor