Provider Demographics
NPI:1962625475
Name:WOOD DALE CHIROPRACTIC, LTD.
Entity type:Organization
Organization Name:WOOD DALE CHIROPRACTIC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:JULIAN
Authorized Official - Last Name:FEINBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-860-0480
Mailing Address - Street 1:402 E IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-1668
Mailing Address - Country:US
Mailing Address - Phone:630-860-0480
Mailing Address - Fax:630-860-9620
Practice Address - Street 1:402 E IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191-1668
Practice Address - Country:US
Practice Address - Phone:630-860-0480
Practice Address - Fax:630-860-9620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-004771111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2282079OtherBLUE CROSS BLUE SHIELD
IL697880Medicare ID - Type Unspecified
IL2282079OtherBLUE CROSS BLUE SHIELD