Provider Demographics
NPI:1770635674
Name:REGAN, KEVIN J (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:REGAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:118 N CLINTON ST
Mailing Address - Street 2:STE # 103
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2386
Mailing Address - Country:US
Mailing Address - Phone:312-876-1600
Mailing Address - Fax:312-876-1616
Practice Address - Street 1:118 N CLINTON ST
Practice Address - Street 2:STE # 103
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-2386
Practice Address - Country:US
Practice Address - Phone:312-876-1600
Practice Address - Fax:312-876-1616
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL038005108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL76828Medicare PIN
T38798Medicare UPIN