Provider Demographics
NPI:1184744617
Name:MEISTER, ENN (DC)
Entity type:Individual
Prefix:DR
First Name:ENN
Middle Name:
Last Name:MEISTER
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 1:1N111 COUNTY FARM RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-2018
Mailing Address - Country:US
Mailing Address - Phone:630-665-6015
Mailing Address - Fax:630-665-5070
Practice Address - Street 1:1N111 COUNTY FARM RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-2018
Practice Address - Country:US
Practice Address - Phone:630-665-6015
Practice Address - Fax:630-665-5070
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL635010Medicare ID - Type Unspecified
ILT37360Medicare UPIN