Provider Demographics
NPI:1861464638
Name:HOSTEN, JOHN MARTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARTIN
Last Name:HOSTEN
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 1:2101 WAUKEGAN RD
Mailing Address - Street 2:STE 100
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1836
Mailing Address - Country:US
Mailing Address - Phone:847-236-1194
Mailing Address - Fax:847-236-1195
Practice Address - Street 1:4541 ROUTE 71
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-7416
Practice Address - Country:US
Practice Address - Phone:630-551-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038020367Medicaid
V05432Medicare UPIN
ILF400202046Medicare PIN