Provider Demographics
NPI:1083964977
Name:NORTHLAKE CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:NORTHLAKE CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-562-9980
Mailing Address - Street 1:157 E NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60164-2523
Mailing Address - Country:US
Mailing Address - Phone:708-562-9980
Mailing Address - Fax:708-562-9983
Practice Address - Street 1:157 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:NORTHLAKE
Practice Address - State:IL
Practice Address - Zip Code:60164-2523
Practice Address - Country:US
Practice Address - Phone:708-562-9980
Practice Address - Fax:708-562-9983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011642111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty