Provider Demographics
NPI:1861684474
Name:SYMMETRY CHIROPRACTIC & WELLNESS, LTD
Entity Type:Organization
Organization Name:SYMMETRY CHIROPRACTIC & WELLNESS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-983-1805
Mailing Address - Street 1:24115 103RD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8012
Mailing Address - Country:US
Mailing Address - Phone:630-983-1805
Mailing Address - Fax:630-983-1845
Practice Address - Street 1:24115 103RD ST
Practice Address - Street 2:SUITE A
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8012
Practice Address - Country:US
Practice Address - Phone:630-983-1805
Practice Address - Fax:630-983-1845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010212111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210425Medicare PIN