Provider Demographics
NPI:1306273180
Name:JULIE L. LOGAN D.C, P.C.
Entity type:Organization
Organization Name:JULIE L. LOGAN D.C, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-327-0471
Mailing Address - Street 1:0N480 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-2934
Mailing Address - Country:US
Mailing Address - Phone:630-327-0471
Mailing Address - Fax:630-260-1230
Practice Address - Street 1:416 E ROOSEVELT RD
Practice Address - Street 2:SUITE 107
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5589
Practice Address - Country:US
Practice Address - Phone:630-682-5090
Practice Address - Fax:630-260-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty