Individual
DR. JOSEPH JOHN ETHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
662 VERNON AVE, GLENCOE, IL 60022-1694
(847) 835-4700
(847) 835-8408
Mailing address
662 VERNON AVE, GLENCOE, IL 60022-1694
(847) 835-4700
(847) 835-8408
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038.011678
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2638686
—
OH
01
—
2867938
MEDICAID GROUP NUMBER
OH
01
—
9358811
MEDICARE GROUP NUMBER
OH
Enumeration date
03/23/2006
Last updated
05/26/2020
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