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Organization
ETHEN CHIROPRACTIC & WELLNESS, SC
Active
Organization
ETHEN CHIROPRACTIC & WELLNESS, SC
Active
Other names
Lakefront Chiropractic Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH JOHN ETHEN DC (PRESIDENT)
(847) 835-4700
Entity
Organization
Contact information
Practice address
630 VERNON AVE, SUITE F, GLENCOE, IL 60022
(847) 835-4700
(847) 835-8408
Mailing address
630 VERNON AVE, SUITE F, GLENCOE, IL 60022
(847) 835-4700
(847) 835-8408
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9358811
MEDICARE GROUP NUMBER
OH
Enumeration date
10/24/2007
Last updated
09/22/2011
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