Provider Demographics
NPI:1205968187
Name:HUGGINS, CARYLLON CUMMINGS (DC,DACBN,CCN)
Entity type:Individual
Prefix:DR
First Name:CARYLLON
Middle Name:CUMMINGS
Last Name:HUGGINS
Suffix:
Gender:F
Credentials:DC,DACBN,CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 GREEN BAY RD STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-2301
Mailing Address - Country:US
Mailing Address - Phone:847-482-1000
Mailing Address - Fax:847-482-1009
Practice Address - Street 1:25 GREEN BAY RD STE B
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-2301
Practice Address - Country:US
Practice Address - Phone:847-482-1000
Practice Address - Fax:847-482-1009
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38007518111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL453072Medicare ID - Type Unspecified
ILU53072Medicare UPIN