Provider Demographics
NPI:1245266287
Name:CHIDLOW, SHANNON L (DC)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:L
Last Name:CHIDLOW
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3626 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:STEGER
Mailing Address - State:IL
Mailing Address - Zip Code:60475-1628
Mailing Address - Country:US
Mailing Address - Phone:708-754-0777
Mailing Address - Fax:708-754-0770
Practice Address - Street 1:22 E 33RD PL
Practice Address - Street 2:
Practice Address - City:STEGER
Practice Address - State:IL
Practice Address - Zip Code:60475-1181
Practice Address - Country:US
Practice Address - Phone:708-754-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9928211OtherBLUECROSS BLUESHIELD
IL88202Medicare UPIN
IL9928211OtherBLUECROSS BLUESHIELD