Provider Demographics
NPI:1093994154
Name:ULTIMATE CHIRO CARE PC
Entity Type:Organization
Organization Name:ULTIMATE CHIRO CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CAMMISA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-778-9000
Mailing Address - Street 1:3590 HOBSON RD
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-5409
Mailing Address - Country:US
Mailing Address - Phone:630-778-9000
Mailing Address - Fax:630-778-9065
Practice Address - Street 1:3590 HOBSON RD STE 301
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-5409
Practice Address - Country:US
Practice Address - Phone:630-778-9000
Practice Address - Fax:630-778-9065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL00290120OtherBLUE CROSS BLUE SHIELD IL
IL00290120OtherBLUECROSS BLUE SHIELD
ILU18376Medicare UPIN