Provider Demographics
NPI:1952606097
Name:DYNAMIC SPORTS FITNESS & CHIROPRACTIC
Entity type:Organization
Organization Name:DYNAMIC SPORTS FITNESS & CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:MACEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-302-0845
Mailing Address - Street 1:716 CLARENDON LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-3226
Mailing Address - Country:US
Mailing Address - Phone:630-302-0845
Mailing Address - Fax:
Practice Address - Street 1:2744 FORGUE DR.
Practice Address - Street 2:C106
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564
Practice Address - Country:US
Practice Address - Phone:630-302-0845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty