Provider Demographics
NPI:1841405628
Name:ELK TRAIL CHIROPRACTIC CLINIC LTD
Entity Type:Organization
Organization Name:ELK TRAIL CHIROPRACTIC CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:TADROS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-221-9700
Mailing Address - Street 1:1425 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3581
Mailing Address - Country:US
Mailing Address - Phone:630-221-9700
Mailing Address - Fax:630-221-9704
Practice Address - Street 1:2100 MANCHESTER RD
Practice Address - Street 2:BLDG B STE 1075B
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187
Practice Address - Country:US
Practice Address - Phone:630-221-9700
Practice Address - Fax:630-221-9704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008501111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty