Provider Demographics
NPI:1780750356
Name:KIRK, JAMES DANIEL (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DANIEL
Last Name:KIRK
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 1:6230 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-1908
Mailing Address - Country:US
Mailing Address - Phone:630-960-9914
Mailing Address - Fax:630-960-9924
Practice Address - Street 1:6230 MAIN ST
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-1908
Practice Address - Country:US
Practice Address - Phone:630-960-9914
Practice Address - Fax:630-960-9924
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010069111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2221717OtherBCBS ID
IL2221717OtherBCBS ID
ILK08778Medicare ID - Type UnspecifiedMEDICARE ID