Provider Demographics
NPI:1942470380
Name:TICKEL CHIROPRACTIC PC
Entity Type:Organization
Organization Name:TICKEL CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:TICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-562-9980
Mailing Address - Street 1:146 E NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60164-2522
Mailing Address - Country:US
Mailing Address - Phone:708-562-9980
Mailing Address - Fax:708-562-9983
Practice Address - Street 1:146 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:NORTHLAKE
Practice Address - State:IL
Practice Address - Zip Code:60164-2522
Practice Address - Country:US
Practice Address - Phone:708-562-9980
Practice Address - Fax:708-562-9983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010926111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty