Provider Demographics
NPI:1104048057
Name:HAZEN CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:HAZEN CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROP.
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ANOTHONY
Authorized Official - Last Name:HAZEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-520-7444
Mailing Address - Street 1:620 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60070-2353
Mailing Address - Country:US
Mailing Address - Phone:847-520-7444
Mailing Address - Fax:847-520-7453
Practice Address - Street 1:620 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:PROSPECT HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60070-2353
Practice Address - Country:US
Practice Address - Phone:847-520-7444
Practice Address - Fax:847-520-7453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0161814OtherBLUE CROSS NO.
IL0161814OtherBLUE CROSS NO.
IL778630Medicare ID - Type UnspecifiedMEDICARE NO.