Provider Demographics
NPI:1083886956
Name:LAKE COOK CHIROPRACTIC HEALTH CARE, INC.
Entity Type:Organization
Organization Name:LAKE COOK CHIROPRACTIC HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GAROZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-726-2273
Mailing Address - Street 1:20370 RAND RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:KILDEER
Mailing Address - State:IL
Mailing Address - Zip Code:60074-2058
Mailing Address - Country:US
Mailing Address - Phone:847-726-2273
Mailing Address - Fax:847-726-2274
Practice Address - Street 1:20370 RAND RD
Practice Address - Street 2:SUITE 104
Practice Address - City:KILDEER
Practice Address - State:IL
Practice Address - Zip Code:60074-2058
Practice Address - Country:US
Practice Address - Phone:847-726-2273
Practice Address - Fax:847-726-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-006836111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL340950Medicare PIN