Provider Demographics
NPI:1871599266
Name:DEAN, JAMES A (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:DEAN
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 1:145 HIAWATHA DR
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-1774
Mailing Address - Country:US
Mailing Address - Phone:630-933-0003
Mailing Address - Fax:630-933-0001
Practice Address - Street 1:145 HIAWATHA DR
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-1774
Practice Address - Country:US
Practice Address - Phone:630-933-0003
Practice Address - Fax:630-933-0001
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2014-12-30
Deactivation Date:2014-12-22
Deactivation Code:
Reactivation Date:2014-12-30
Provider Licenses
StateLicense IDTaxonomies
IL038-004068111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T374493Medicare UPIN
653290Medicare ID - Type Unspecified