Provider Demographics
NPI:1922261072
Name:GENTLE HANDS CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:GENTLE HANDS CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:BRAITHWAITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-458-2225
Mailing Address - Street 1:140 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BRAIDWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60408-1703
Mailing Address - Country:US
Mailing Address - Phone:815-458-2225
Mailing Address - Fax:
Practice Address - Street 1:505 W KENNEDY RD
Practice Address - Street 2:
Practice Address - City:BRAIDWOOD
Practice Address - State:IL
Practice Address - Zip Code:60408-1931
Practice Address - Country:US
Practice Address - Phone:815-458-2225
Practice Address - Fax:866-272-7518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011199111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty