Provider Demographics
NPI:1841967817
Name:HACH, GRACE (DC)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:HACH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 N KIRK RD STE 103
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-1667
Mailing Address - Country:US
Mailing Address - Phone:630-605-6323
Mailing Address - Fax:
Practice Address - Street 1:429 N KIRK RD STE 103
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-1667
Practice Address - Country:US
Practice Address - Phone:630-605-6323
Practice Address - Fax:877-511-8780
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038013760OtherLICENSE