Provider Demographics
NPI:1972553154
Name:HOAD, DOUGLAS WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:WILLIAM
Last Name:HOAD
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 1:34 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-1986
Mailing Address - Country:US
Mailing Address - Phone:630-761-1314
Mailing Address - Fax:630-482-3093
Practice Address - Street 1:34 N WATER ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1986
Practice Address - Country:US
Practice Address - Phone:630-761-1314
Practice Address - Fax:630-482-3093
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007837111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU59333Medicare UPIN