Provider Demographics
NPI:1043437015
Name:PARK RIDGE CHIROPRACTIC
Entity Type:Organization
Organization Name:PARK RIDGE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHENNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-318-1144
Mailing Address - Street 1:32 MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068
Mailing Address - Country:US
Mailing Address - Phone:847-318-1144
Mailing Address - Fax:847-318-8866
Practice Address - Street 1:32 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068
Practice Address - Country:US
Practice Address - Phone:847-318-1144
Practice Address - Fax:847-318-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636992OtherBCBS
IL215354OtherMEDICARE