Provider Demographics
NPI:1043417066
Name:ST.GERMAIN CHIROPRACTIC CTR
Entity Type:Organization
Organization Name:ST.GERMAIN CHIROPRACTIC CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERMAINE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:ST.GERMAIN
Authorized Official - Suffix:
Authorized Official - Credentials:CHIROPRACTOR
Authorized Official - Phone:630-620-7900
Mailing Address - Street 1:13 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2554
Mailing Address - Country:US
Mailing Address - Phone:630-620-7900
Mailing Address - Fax:
Practice Address - Street 1:13 S PARK AVE
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2554
Practice Address - Country:US
Practice Address - Phone:630-620-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL68-2290Medicare ID - Type UnspecifiedMEDICARE PROVIDER
IL02215249Medicare UPIN