Provider Demographics
NPI:1760816854
Name:OTTAWA CHIROPRACTIC
Entity Type:Organization
Organization Name:OTTAWA CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V-PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FLAHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-431-8303
Mailing Address - Street 1:1001 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-2039
Mailing Address - Country:US
Mailing Address - Phone:815-431-8303
Mailing Address - Fax:815-431-8327
Practice Address - Street 1:1001 CLINTON ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-2039
Practice Address - Country:US
Practice Address - Phone:815-431-8303
Practice Address - Fax:815-431-8327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty