Provider Demographics
NPI:1588969208
Name:FOX VALLEY CARE CLINIC LTD
Entity type:Organization
Organization Name:FOX VALLEY CARE CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:FRAZER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-551-0000
Mailing Address - Street 1:2685 US HIGHWAY 34
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8577
Mailing Address - Country:US
Mailing Address - Phone:630-551-0000
Mailing Address - Fax:630-551-1510
Practice Address - Street 1:2685 US HIGHWAY 34
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8577
Practice Address - Country:US
Practice Address - Phone:630-551-0000
Practice Address - Fax:630-551-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042.617249111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU83065Medicare UPIN