Provider Demographics
NPI:1134512668
Name:NORTHBROOK CHIROPRACTIC AND NATURAL CARE CENTER SC
Entity Type:Organization
Organization Name:NORTHBROOK CHIROPRACTIC AND NATURAL CARE CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:224-817-2273
Mailing Address - Street 1:1500 SHERMER RD STE 1SE
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-5343
Mailing Address - Country:US
Mailing Address - Phone:224-817-2273
Mailing Address - Fax:224-415-3706
Practice Address - Street 1:1500 SHERMER RD STE 1SE
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-5343
Practice Address - Country:US
Practice Address - Phone:224-817-2273
Practice Address - Fax:224-415-3706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010408261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service