Provider Demographics
NPI:1710190830
Name:ADVANTAGE CHIROPRACTIC
Entity Type:Organization
Organization Name:ADVANTAGE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:630-351-9135
Mailing Address - Street 1:980 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-3354
Mailing Address - Country:US
Mailing Address - Phone:630-351-9135
Mailing Address - Fax:630-523-5450
Practice Address - Street 1:980 LAKE ST
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-3354
Practice Address - Country:US
Practice Address - Phone:630-351-9135
Practice Address - Fax:630-523-5450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty