Provider Demographics
NPI:1700065521
Name:LEE ECHELBARGER INCORPORATED
Entity Type:Organization
Organization Name:LEE ECHELBARGER INCORPORATED
Other - Org Name:BACK IN LINE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:B
Authorized Official - Last Name:ECHELBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-781-9595
Mailing Address - Street 1:740 E SCHAUMBURG RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3508
Mailing Address - Country:US
Mailing Address - Phone:847-781-9595
Mailing Address - Fax:847-781-1799
Practice Address - Street 1:740 E SCHAUMBURG RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-3508
Practice Address - Country:US
Practice Address - Phone:847-781-9595
Practice Address - Fax:847-781-1799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632113OtherBLUE CROSS BLUE SHIELD
IL01632113OtherBLUE CROSS BLUE SHIELD