Provider Demographics
NPI:1457633125
Name:FUNCTIONAL HEALTH CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:FUNCTIONAL HEALTH CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/ DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOLLANDSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-605-8835
Mailing Address - Street 1:957 N PLUM GROVE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5194
Mailing Address - Country:US
Mailing Address - Phone:847-605-8835
Mailing Address - Fax:847-565-4199
Practice Address - Street 1:957 N PLUM GROVE RD
Practice Address - Street 2:SUITE A
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5194
Practice Address - Country:US
Practice Address - Phone:847-605-8835
Practice Address - Fax:847-565-4199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-19
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011795111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty