Organization
FREDERICKS CHIROPRACTIC CENTER, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN A FREDERICKS DC (PRESIDENT)
(630) 665-5656
Entity
Organization
Contact information
Practice address
166 N GARY AVE, CAROL STREAM, IL 60188-2093
(630) 665-5656
Mailing address
166 N GARY AVE, CAROL STREAM, IL 60188-2093
(630) 665-5656
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038005902
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2215441
BLUE CROSS BLUE SHIELD OF ILLINOIS
IL
01
—
764930
MEDICARE
IL
01
—
T38747
UPIN
IL
Enumeration date
06/18/2008
Last updated
06/18/2008
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