Provider Demographics
NPI:1134635618
Name:AMEN CLINICS, INC CHICAGO
Entity Type:Organization
Organization Name:AMEN CLINICS, INC CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE TRAINER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-880-4000
Mailing Address - Street 1:2333 WAUKEGAN RD STE 150
Mailing Address - Street 2:
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1563
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2333 WAUKEGAN RD STE 150
Practice Address - Street 2:
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1563
Practice Address - Country:US
Practice Address - Phone:224-804-9220
Practice Address - Fax:224-241-3154
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMEN CLINICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-20
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic NeuroimagingGroup - Multi-Specialty