Provider Demographics
NPI:1730184862
Name:VAN TIL, RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:VAN TIL
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 1:404 S KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915-2137
Mailing Address - Country:US
Mailing Address - Phone:815-929-9296
Mailing Address - Fax:815-929-9667
Practice Address - Street 1:404 S KENNEDY DR
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-2137
Practice Address - Country:US
Practice Address - Phone:815-929-9296
Practice Address - Fax:815-929-9667
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010127111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4632052OtherBLUE CROSS BLUE SHIELD
IL209256Medicare ID - Type Unspecified
IL4632052OtherBLUE CROSS BLUE SHIELD