Provider Demographics
NPI:1356602148
Name:GO CHIROPRACTIC
Entity type:Organization
Organization Name:GO CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-428-0201
Mailing Address - Street 1:1300 IROQUOIS AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8493
Mailing Address - Country:US
Mailing Address - Phone:630-428-0201
Mailing Address - Fax:630-429-9340
Practice Address - Street 1:1300 IROQUOIS AVE STE 270
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8493
Practice Address - Country:US
Practice Address - Phone:630-428-0201
Practice Address - Fax:630-429-9340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012162111N00000X
IL038012161111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty