Provider Demographics
NPI:1922047984
Name:MASSEY FAMILY CHIROPRACTIC & WELLNESS CENTER PC
Entity Type:Organization
Organization Name:MASSEY FAMILY CHIROPRACTIC & WELLNESS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-444-1599
Mailing Address - Street 1:2435 DEAN STREET
Mailing Address - Street 2:UNIT D
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-4827
Mailing Address - Country:US
Mailing Address - Phone:630-444-1599
Mailing Address - Fax:630-444-1825
Practice Address - Street 1:2435 DEAN STREET
Practice Address - Street 2:UNIT D
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-4827
Practice Address - Country:US
Practice Address - Phone:630-444-1599
Practice Address - Fax:630-444-1825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04532295OtherBLUE CROSS BLUS SHIELD