Provider Demographics
NPI:1841526092
Name:EVANSTON CHIROPRACTIC CENTER INC.
Entity type:Organization
Organization Name:EVANSTON CHIROPRACTIC CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-789-4957
Mailing Address - Street 1:624 W CHEYENNE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-5517
Mailing Address - Country:US
Mailing Address - Phone:307-789-4957
Mailing Address - Fax:307-789-4959
Practice Address - Street 1:624 W CHEYENNE DR STE 3
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-5517
Practice Address - Country:US
Practice Address - Phone:307-679-4429
Practice Address - Fax:307-789-4959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW303389Medicare PIN