Provider Demographics
NPI:1992875207
Name:CAIN, DOUGLAS J (DC, LAC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:J
Last Name:CAIN
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 MCHENRY AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7445
Mailing Address - Country:US
Mailing Address - Phone:815-479-0200
Mailing Address - Fax:815-479-0260
Practice Address - Street 1:741 MCHENRY AVE
Practice Address - Street 2:SUITE C
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7445
Practice Address - Country:US
Practice Address - Phone:815-479-0200
Practice Address - Fax:815-479-0260
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05608615OtherBCBS
IL05608615OtherBCBS
ILT38917Medicare UPIN