Provider Demographics
NPI:1184494692
Name:KINGSLEY, JOHN SPENCER (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SPENCER
Last Name:KINGSLEY
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 1:5545 W MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-1331
Mailing Address - Country:US
Mailing Address - Phone:630-282-6648
Mailing Address - Fax:
Practice Address - Street 1:5545 W MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-1331
Practice Address - Country:US
Practice Address - Phone:517-425-0598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.014107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor