Provider Demographics
NPI:1912018102
Name:ERIC D SOULE DC PC
Entity Type:Organization
Organization Name:ERIC D SOULE DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SOULE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-988-9655
Mailing Address - Street 1:1150 N STATE ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-7481
Mailing Address - Country:US
Mailing Address - Phone:312-988-9655
Mailing Address - Fax:312-988-7060
Practice Address - Street 1:1150 N STATE ST
Practice Address - Street 2:SUITE 310
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-7481
Practice Address - Country:US
Practice Address - Phone:312-988-9655
Practice Address - Fax:312-988-7060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2907111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U97492Medicare UPIN
449166Medicare ID - Type Unspecified
IL207458Medicare ID - Type Unspecified