Provider Demographics
NPI:1063638674
Name:PHYSICIANS PLUS NORTH LTD
Entity Type:Organization
Organization Name:PHYSICIANS PLUS NORTH LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MARANDO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:773-348-0033
Mailing Address - Street 1:1700 W DIVERSEY PKWY
Mailing Address - Street 2:SUITE 2W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1010
Mailing Address - Country:US
Mailing Address - Phone:773-348-0033
Mailing Address - Fax:773-348-0553
Practice Address - Street 1:1700 W DIVERSEY PKWY
Practice Address - Street 2:SUITE 2W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1010
Practice Address - Country:US
Practice Address - Phone:773-348-0033
Practice Address - Fax:773-348-0553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042617987111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1632107OtherBLUE CROSS BLUE SHIELD
ILUP3166Medicare UPIN
IL203826Medicare ID - Type Unspecified