Provider Demographics
NPI:1790838571
Name:EADLER, JUSTIN SETH (DC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:SETH
Last Name:EADLER
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 1:757 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-2108
Mailing Address - Country:US
Mailing Address - Phone:847-844-4100
Mailing Address - Fax:847-844-4991
Practice Address - Street 1:757 S 8TH ST
Practice Address - Street 2:
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-2108
Practice Address - Country:US
Practice Address - Phone:847-844-4100
Practice Address - Fax:847-844-4991
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU86769Medicare UPIN
IL938540Medicare ID - Type Unspecified