Organization
FORM AND FUNCTION PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANE GETALD MCTAGUE DC (OWNER)
(815) 217-4964
Entity
Organization
Contact information
Practice address
1512 N FREMONT ST STE 104, CHICAGO, IL 60642-2567
(815) 217-4964
Mailing address
1512 N FREMONT ST STE 104, CHICAGO, IL 60642-2567
(815) 217-4964
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Enumeration date
06/01/2026
Last updated
06/01/2026
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