Provider Demographics
NPI:1114074069
Name:SCHELFHOUT CHIROPRACTIC CLINIC LTD
Entity Type:Organization
Organization Name:SCHELFHOUT CHIROPRACTIC CLINIC LTD
Other - Org Name:NORTHWEST CHIROPRACTIC AND FAMILY WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHELFHOUT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-577-8061
Mailing Address - Street 1:3455 W SALT CREEK LN
Mailing Address - Street 2:SUITE #500
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1090
Mailing Address - Country:US
Mailing Address - Phone:847-577-8061
Mailing Address - Fax:847-577-8358
Practice Address - Street 1:3455 W SALT CREEK LN
Practice Address - Street 2:SUITE #500
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1090
Practice Address - Country:US
Practice Address - Phone:847-577-8061
Practice Address - Fax:847-577-8358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007537111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1627852OtherBLUECROSS BLUESHIELD
ILU52064Medicare UPIN
IL910090Medicare ID - Type Unspecified