Provider Demographics
NPI:1760905558
Name:MENTON, CHRIS (DC)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:MENTON
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 1:54 63RD ST
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-2982
Mailing Address - Country:US
Mailing Address - Phone:630-920-1097
Mailing Address - Fax:
Practice Address - Street 1:54 63RD ST
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-2982
Practice Address - Country:US
Practice Address - Phone:630-920-1097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-24
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013098111N00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies