Provider Demographics
NPI:1831285311
Name:DES PLAINES CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:DES PLAINES CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:WHITTIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:897-299-3440
Mailing Address - Street 1:444 LEE ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016
Mailing Address - Country:US
Mailing Address - Phone:847-299-3440
Mailing Address - Fax:847-299-3441
Practice Address - Street 1:444 LEE ST
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016
Practice Address - Country:US
Practice Address - Phone:847-299-3440
Practice Address - Fax:847-299-3441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006080111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
566630Medicare ID - Type Unspecified