Provider Demographics
NPI:1851598973
Name:CENTRAL DUPAGE CHIROPRACTIC AND REHABILITATION INC
Entity Type:Organization
Organization Name:CENTRAL DUPAGE CHIROPRACTIC AND REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLO
Authorized Official - Middle Name:RODERICK
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-665-7266
Mailing Address - Street 1:923 E ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5650
Mailing Address - Country:US
Mailing Address - Phone:630-665-7266
Mailing Address - Fax:630-665-7278
Practice Address - Street 1:200 E WILLOW AVE STE 202
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5445
Practice Address - Country:US
Practice Address - Phone:630-665-7266
Practice Address - Fax:630-665-7278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010253111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILV08426Medicare UPIN
IL213090Medicare ID - Type Unspecified