Provider Demographics
NPI:1790938744
Name:LIFE SPRING CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:LIFE SPRING CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:REGINA
Authorized Official - Last Name:GASKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-776-6379
Mailing Address - Street 1:1420 COLONY CT
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4416
Mailing Address - Country:US
Mailing Address - Phone:630-776-6379
Mailing Address - Fax:331-642-1219
Practice Address - Street 1:381 N YORK ST
Practice Address - Street 2:STE 23
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2364
Practice Address - Country:US
Practice Address - Phone:630-478-9311
Practice Address - Fax:331-642-1219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2015-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008719111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2264221OtherUHC
IL0002232247OtherBCBS OF ILLINOIS
IL1991192OtherFIRST HEALTH
IL4236188OtherCIGNA
IL7916367OtherAETNA
IL646275OtherACN
IL0002232247OtherBCBS OF ILLINOIS
IL2264221OtherUHC