Provider Demographics
NPI:1730247925
Name:CHEVERE, WILFREDO (DC)
Entity type:Individual
Prefix:DR
First Name:WILFREDO
Middle Name:
Last Name:CHEVERE
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 1:375 N CEDAR LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-2816
Mailing Address - Country:US
Mailing Address - Phone:847-740-9077
Mailing Address - Fax:847-740-5377
Practice Address - Street 1:375 N CEDAR LAKE RD
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073-2816
Practice Address - Country:US
Practice Address - Phone:847-740-9077
Practice Address - Fax:847-740-5377
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU75199Medicare UPIN