Provider Demographics
NPI:1871715458
Name:HERAZY, THEODORE R (DC)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:R
Last Name:HERAZY
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 1:1933 N EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-3173
Mailing Address - Country:US
Mailing Address - Phone:847-873-8888
Mailing Address - Fax:847-670-8800
Practice Address - Street 1:504 N PLUM GROVE RD
Practice Address - Street 2:SUITE C
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-8207
Practice Address - Country:US
Practice Address - Phone:847-358-0010
Practice Address - Fax:847-358-8244
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor