Provider Demographics
NPI:1154628717
Name:GOLF ROAD BACK AND NECK CLINIC, S.C.
Entity Type:Organization
Organization Name:GOLF ROAD BACK AND NECK CLINIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SORIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-401-7292
Mailing Address - Street 1:9194 W GOLF RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-5806
Mailing Address - Country:US
Mailing Address - Phone:847-401-7292
Mailing Address - Fax:
Practice Address - Street 1:9194 W GOLF RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-5806
Practice Address - Country:US
Practice Address - Phone:847-401-7292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty