Provider Demographics
NPI:1053669580
Name:CATALYST CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CATALYST CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-767-3822
Mailing Address - Street 1:313 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-1633
Mailing Address - Country:US
Mailing Address - Phone:815-312-4922
Mailing Address - Fax:773-337-9106
Practice Address - Street 1:313 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-1633
Practice Address - Country:US
Practice Address - Phone:815-312-4922
Practice Address - Fax:773-337-9106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty