Provider Demographics
NPI:1760598775
Name:DEVER, DANIELLE S (DC)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:S
Last Name:DEVER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S MICHIGAN AVE
Mailing Address - Street 2:SUITE 1560
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-6191
Mailing Address - Country:US
Mailing Address - Phone:312-939-4121
Mailing Address - Fax:312-939-8011
Practice Address - Street 1:122 S MICHIGAN AVE
Practice Address - Street 2:SUITE 1560
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-6191
Practice Address - Country:US
Practice Address - Phone:312-939-4121
Practice Address - Fax:312-939-8011
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010458111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038010458OtherST LIC NO
IL200765OtherGROUP MEDICARE PIN
K35195Medicare ID - Type Unspecified