Provider Demographics
NPI:1861557886
Name:HINLEY, GERARD CARR (DC)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:CARR
Last Name:HINLEY
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 1:954 CRESCENT BLVD
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-4255
Mailing Address - Country:US
Mailing Address - Phone:630-469-9233
Mailing Address - Fax:630-690-4680
Practice Address - Street 1:1136 BLOOMINGDALE RD
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-3498
Practice Address - Country:US
Practice Address - Phone:630-690-4488
Practice Address - Fax:630-690-4680
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
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
IL0221-5600OtherBLUE CROSS BLUE SHIELD
IL911870Medicare ID - Type Unspecified
ILT90442Medicare UPIN