Provider Demographics
NPI:1952346892
Name:MINKLER, DEANNA L (DC)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:L
Last Name:MINKLER
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 1:6160 N CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4312
Mailing Address - Country:US
Mailing Address - Phone:773-283-4470
Mailing Address - Fax:773-767-3944
Practice Address - Street 1:6160 N CICERO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4312
Practice Address - Country:US
Practice Address - Phone:773-283-4470
Practice Address - Fax:773-767-3944
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008210111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636131OtherBC/BS PROVIDER #
IL01636131OtherBC/BS PROVIDER #