Provider Demographics
NPI:1982646246
Name:NYULI CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:NYULI CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NYULI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-584-5800
Mailing Address - Street 1:302 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2511
Mailing Address - Country:US
Mailing Address - Phone:630-584-5800
Mailing Address - Fax:630-584-6190
Practice Address - Street 1:302 S 14TH ST
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2511
Practice Address - Country:US
Practice Address - Phone:630-584-5800
Practice Address - Fax:630-584-6190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038003148111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4532273OtherBLUE CROSS BLUE SHIELD
IL4532273OtherBLUE CROSS BLUE SHIELD
IL=========OtherPRIVATE HEALTHCARE SYSTEM
IL=========OtherHUMANA
IL=========OtherPRINCIPLE