Provider Demographics
NPI:1972629111
Name:JEVITZ CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:JEVITZ CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:JEVITZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:630-834-3391
Mailing Address - Street 1:135 S ROBERT T PALMER DR
Mailing Address - Street 2:SUITE 23
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3412
Mailing Address - Country:US
Mailing Address - Phone:630-834-3391
Mailing Address - Fax:630-834-3390
Practice Address - Street 1:135 S ROBERT T PALMER DR
Practice Address - Street 2:SUITE 23
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-3412
Practice Address - Country:US
Practice Address - Phone:630-834-3391
Practice Address - Fax:630-834-3390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU33598Medicare UPIN
IL983750Medicare ID - Type Unspecified