Provider Demographics
NPI:1083682264
Name:ZRELAK CHIROPRACTIC CENTER, S.C.
Entity Type:Organization
Organization Name:ZRELAK CHIROPRACTIC CENTER, S.C.
Other - Org Name:EAST BANK CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ZRELAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-832-9700
Mailing Address - Street 1:414 N ORLEANS ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-4493
Mailing Address - Country:US
Mailing Address - Phone:312-832-9700
Mailing Address - Fax:312-832-9702
Practice Address - Street 1:414 N ORLEANS ST
Practice Address - Street 2:SUITE 207
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-4493
Practice Address - Country:US
Practice Address - Phone:312-832-9700
Practice Address - Fax:312-832-9702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL384400OtherMEDICARE GROUP
ILP00095819OtherRR MEDICARE
IL384400OtherMEDICARE GROUP
U39321Medicare UPIN