Provider Demographics
NPI:1043667199
Name:BACK AND NECK PAIN RELIEF OF OAK LAWN
Entity Type:Organization
Organization Name:BACK AND NECK PAIN RELIEF OF OAK LAWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:MCVADY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-220-0599
Mailing Address - Street 1:3619 W 79TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-1801
Mailing Address - Country:US
Mailing Address - Phone:708-220-0599
Mailing Address - Fax:
Practice Address - Street 1:4550 W 103RD ST
Practice Address - Street 2:STE 3B
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4866
Practice Address - Country:US
Practice Address - Phone:708-220-0599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty