Provider Demographics
NPI:1003948480
Name:FAMILY CARE CHIROPRACTIC CENTER OF NEW LENOX PC
Entity Type:Organization
Organization Name:FAMILY CARE CHIROPRACTIC CENTER OF NEW LENOX PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:DERRIK
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:BS, BS, DC
Authorized Official - Phone:815-463-1130
Mailing Address - Street 1:2571 E LINCOLN HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9529
Mailing Address - Country:US
Mailing Address - Phone:815-463-1130
Mailing Address - Fax:815-463-1150
Practice Address - Street 1:2571 E LINCOLN HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9529
Practice Address - Country:US
Practice Address - Phone:815-463-1130
Practice Address - Fax:815-463-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-11
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-005723111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL566370Medicare PIN
ILK47627Medicare PIN
IL481969789Medicare ID - Type Unspecified