Provider Demographics
NPI:1548472020
Name:DOUGHERTY FAMILY CHIROPRACTIC PC
Entity type:Organization
Organization Name:DOUGHERTY FAMILY CHIROPRACTIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:DOUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-904-6700
Mailing Address - Street 1:11258 IL-59 #2
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8090
Mailing Address - Country:US
Mailing Address - Phone:630-904-6700
Mailing Address - Fax:630-904-6701
Practice Address - Street 1:11258 IL-59 #2
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8090
Practice Address - Country:US
Practice Address - Phone:630-904-6700
Practice Address - Fax:630-904-6701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010821111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty