Provider Demographics
NPI:1437155272
Name:MOHLSTROM, CAROLINE A (DC)
Entity type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:A
Last Name:MOHLSTROM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 S CLAY ST
Mailing Address - Street 2:STE 241E
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-0559
Mailing Address - Country:US
Mailing Address - Phone:630-654-9300
Mailing Address - Fax:630-654-8911
Practice Address - Street 1:40 S CLAY ST
Practice Address - Street 2:STE 241E
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-0559
Practice Address - Country:US
Practice Address - Phone:630-654-9300
Practice Address - Fax:630-654-8911
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL355980Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION N