Provider Demographics
NPI:1730339334
Name:DOLAN FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:DOLAN FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:DOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-236-3090
Mailing Address - Street 1:1137 N EOLA RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-7096
Mailing Address - Country:US
Mailing Address - Phone:630-236-3090
Mailing Address - Fax:630-236-3092
Practice Address - Street 1:1137 N EOLA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-7096
Practice Address - Country:US
Practice Address - Phone:630-236-3090
Practice Address - Fax:630-236-3092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011013111N00000X
IL038011016111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2233886OtherBC/BS
IL2233886OtherBC/BS