Provider Demographics
NPI:1780862607
Name:ESSENTIAL CHIROPRACTIC CENTER SC
Entity Type:Organization
Organization Name:ESSENTIAL CHIROPRACTIC CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAGMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-718-0554
Mailing Address - Street 1:1020 104TH STREET
Mailing Address - Street 2:100
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5504
Mailing Address - Country:US
Mailing Address - Phone:630-718-0554
Mailing Address - Fax:
Practice Address - Street 1:1020 104TH STREET
Practice Address - Street 2:100
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5504
Practice Address - Country:US
Practice Address - Phone:630-718-0554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009122111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209533Medicare UPIN