Provider Demographics
NPI:1962514513
Name:INITIUM INC.
Entity type:Organization
Organization Name:INITIUM INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-312-7700
Mailing Address - Street 1:1445 N STATE PKWY
Mailing Address - Street 2:1207
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1565
Mailing Address - Country:US
Mailing Address - Phone:847-312-7700
Mailing Address - Fax:
Practice Address - Street 1:1445 N STATE PKWY
Practice Address - Street 2:1207
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-1565
Practice Address - Country:US
Practice Address - Phone:847-312-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208839Medicare ID - Type UnspecifiedCHIROPRACTOR