Provider Demographics
NPI:1720201957
Name:MENNER CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:MENNER CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:MENNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-540-6060
Mailing Address - Street 1:110 S WYNSTONE PARK DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NORTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-6979
Mailing Address - Country:US
Mailing Address - Phone:847-540-6060
Mailing Address - Fax:847-277-8012
Practice Address - Street 1:110 S WYNSTONE PARK DR
Practice Address - Street 2:SUITE 105
Practice Address - City:NORTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-6979
Practice Address - Country:US
Practice Address - Phone:847-540-6060
Practice Address - Fax:847-277-8012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4923238OtherBCBSIL
ILT92977Medicare UPIN
914300Medicare PIN