Provider Demographics
NPI:1902133580
Name:MIDWEST UPPER CERVICAL
Entity Type:Organization
Organization Name:MIDWEST UPPER CERVICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:N
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-685-1663
Mailing Address - Street 1:1005 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-9621
Mailing Address - Country:US
Mailing Address - Phone:815-685-1663
Mailing Address - Fax:
Practice Address - Street 1:1005 RIDGE RD
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-9621
Practice Address - Country:US
Practice Address - Phone:815-685-1663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011501111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty