Provider Demographics
NPI:1760546840
Name:DALE, RICHARD FRANCIS (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:FRANCIS
Last Name:DALE
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 1:555 PLAINFIELD RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7602
Mailing Address - Country:US
Mailing Address - Phone:630-325-7900
Mailing Address - Fax:630-325-7940
Practice Address - Street 1:555 PLAINFIELD RD
Practice Address - Street 2:SUITE C
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-7602
Practice Address - Country:US
Practice Address - Phone:630-325-7900
Practice Address - Fax:630-325-7940
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232845OtherBCBS PIN
IL02232845OtherBCBS PIN
ILK23860Medicare PIN