Provider Demographics
NPI:1972678787
Name:KLARICH, JULIE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANN
Last Name:KLARICH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 N OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:OAKPARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301
Mailing Address - Country:US
Mailing Address - Phone:708-848-8488
Mailing Address - Fax:708-848-8480
Practice Address - Street 1:126 N OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:OAKPARK
Practice Address - State:IL
Practice Address - Zip Code:60301
Practice Address - Country:US
Practice Address - Phone:708-848-8488
Practice Address - Fax:708-848-8480
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
01619002OtherBC BS
IL318970Medicare ID - Type Unspecified