Provider Demographics
NPI:1679614333
Name:DYNAMIC CHIROPRACTIC CARE, LTD.
Entity type:Organization
Organization Name:DYNAMIC CHIROPRACTIC CARE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JAKUBIEC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-243-7437
Mailing Address - Street 1:14581 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-4599
Mailing Address - Country:US
Mailing Address - Phone:630-243-7437
Mailing Address - Fax:
Practice Address - Street 1:14581 ALBANY AVE.
Practice Address - Street 2:SUITE 700
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439
Practice Address - Country:US
Practice Address - Phone:630-243-7437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009493111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K14832Medicare ID - Type Unspecified
ILV03833Medicare UPIN