Provider Demographics
NPI:1962150136
Name:SUMMERS, TY (DC)
Entity type:Individual
Prefix:DR
First Name:TY
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:884 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-1226
Mailing Address - Country:US
Mailing Address - Phone:847-395-1110
Mailing Address - Fax:847-395-2630
Practice Address - Street 1:884 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-1226
Practice Address - Country:US
Practice Address - Phone:847-395-1110
Practice Address - Fax:847-395-2630
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013852111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor