Provider Demographics
NPI:1174680086
Name:LINCOLN-WAY CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:LINCOLN-WAY CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:KIRBY
Authorized Official - Last Name:KOSEK
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:815-485-8200
Mailing Address - Street 1:195 S. MARLEY RD.
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451
Mailing Address - Country:US
Mailing Address - Phone:815-485-8200
Mailing Address - Fax:815-485-8996
Practice Address - Street 1:195 S. MARLEY RD.
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451
Practice Address - Country:US
Practice Address - Phone:815-485-8200
Practice Address - Fax:815-485-8996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL248001336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL350056318OtherRAILROAD MEDICARE
IL350056318OtherRAILROAD MEDICARE