Provider Demographics
NPI:1780844944
Name:ESSENTIAL HEALTH CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:ESSENTIAL HEALTH CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:GARNETT
Authorized Official - Last Name:DUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-345-6251
Mailing Address - Street 1:625 ROGER WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4840
Mailing Address - Country:US
Mailing Address - Phone:608-345-6251
Mailing Address - Fax:630-737-0310
Practice Address - Street 1:625 ROGER WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-4840
Practice Address - Country:US
Practice Address - Phone:608-345-6251
Practice Address - Fax:630-737-0310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty