Provider Demographics
NPI:1023051125
Name:HAYES, JEREMY TODD (DC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:TODD
Last Name:HAYES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 BUTTERFIELD RD
Mailing Address - Street 2:SUITE 301N
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1234
Mailing Address - Country:US
Mailing Address - Phone:630-320-6400
Mailing Address - Fax:630-701-1007
Practice Address - Street 1:3486 VOLLMER RD
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1018
Practice Address - Country:US
Practice Address - Phone:708-481-5444
Practice Address - Fax:708-481-5495
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038009219OtherSTATE LICENSE
IL1635702OtherBLUE CROSS ID #
IL038009219OtherSTATE LICENSE
IL213109Medicare PIN
ILU84757Medicare UPIN