Provider Demographics
NPI:1265644157
Name:THE DOCTORS INN
Entity type:Organization
Organization Name:THE DOCTORS INN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-254-0044
Mailing Address - Street 1:12337 S ROUTE 59
Mailing Address - Street 2:SUITE 119
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-4625
Mailing Address - Country:US
Mailing Address - Phone:815-254-0044
Mailing Address - Fax:815-254-0880
Practice Address - Street 1:12337 S ROUTE 59
Practice Address - Street 2:SUITE 119
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-4625
Practice Address - Country:US
Practice Address - Phone:815-254-0044
Practice Address - Fax:815-254-0880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9932222OtherBLUE SHEILD
ILDE4564OtherRR
IL9932222OtherBLUE SHEILD