Provider Demographics
NPI:1962681080
Name:BLOOMINGDALE CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:BLOOMINGDALE CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-980-5460
Mailing Address - Street 1:209 E ARMY TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-1758
Mailing Address - Country:US
Mailing Address - Phone:630-980-5640
Mailing Address - Fax:630-980-9835
Practice Address - Street 1:209 E ARMY TRAIL RD
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-1758
Practice Address - Country:US
Practice Address - Phone:630-980-5640
Practice Address - Fax:630-980-9835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL653290Medicare PIN