Provider Demographics
NPI:1154530947
Name:IVERS CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:IVERS CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:IVERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-455-1919
Mailing Address - Street 1:1024 MCHENRY AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7477
Mailing Address - Country:US
Mailing Address - Phone:815-455-1919
Mailing Address - Fax:815-455-1455
Practice Address - Street 1:1024 MCHENRY AVE
Practice Address - Street 2:SUITE E
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7477
Practice Address - Country:US
Practice Address - Phone:815-455-1919
Practice Address - Fax:815-455-1455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006274111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1801804919OtherNPI
IL038006274Medicaid
IL038006274Medicaid