Provider Demographics
NPI:1134201668
Name:EXPERIENCE CHIROPRACTIC
Entity type:Organization
Organization Name:EXPERIENCE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:WARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-313-8862
Mailing Address - Street 1:1971 N FREMONT ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3591
Mailing Address - Country:US
Mailing Address - Phone:480-313-8862
Mailing Address - Fax:773-409-5706
Practice Address - Street 1:1971 N FREMONT ST
Practice Address - Street 2:SUITE 3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3591
Practice Address - Country:US
Practice Address - Phone:480-313-8862
Practice Address - Fax:773-409-5706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ85232Medicare PIN