Provider Demographics
NPI:1457759151
Name:CUNDIFF, ERIC ELLIOTT (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ELLIOTT
Last Name:CUNDIFF
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ERIC
Other - Middle Name:ELLIOTT
Other - Last Name:CUNDIFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:128 WALLACE STREET
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-6521
Mailing Address - Country:US
Mailing Address - Phone:847-385-8636
Mailing Address - Fax:
Practice Address - Street 1:1600 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3145
Practice Address - Country:US
Practice Address - Phone:630-510-7799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012731111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor