1407211832 NPI number — BARTLETT CHIROPRACTIC CLINIC, SC

Table of content: DR. JULIE ANN GRECO PHARM.D. (NPI 1104025642)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407211832 NPI number — BARTLETT CHIROPRACTIC CLINIC, SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARTLETT CHIROPRACTIC CLINIC, SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407211832
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
314 W ROLLINS RD
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
ROUND LAKE BEACH
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60073-1204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-546-4220
Provider Business Mailing Address Fax Number:
847-546-4262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
314 W ROLLINS RD
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
ROUND LAKE BEACH
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60073-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-546-4220
Provider Business Practice Location Address Fax Number:
847-546-4262
Provider Enumeration Date:
12/30/2015

Additional Information

Authorized Official

Authorized Official Last Name:
RICHARD
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
321-795-7497

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  038010561 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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