1659551943 NPI number — COLEMAN CHIROPRACTIC CENTER, LTD.

Table of content: ZOE VAN DEN BERG (NPI 1710703699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659551943 NPI number — COLEMAN CHIROPRACTIC CENTER, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLEMAN CHIROPRACTIC CENTER, LTD.
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:
1659551943
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1308 SUNSET AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORKVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60560-1173
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-553-7600
Provider Business Mailing Address Fax Number:
630-553-1306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1308 SUNSET AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORKVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60560-1173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-553-7600
Provider Business Practice Location Address Fax Number:
630-553-1306
Provider Enumeration Date:
11/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COLEMAN
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
630-553-7600

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , 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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