Provider Demographics
NPI:1194831834
Name:SOUTHWEST HOLISTIC CHIROPRACTIC, LTD.
Entity Type:Organization
Organization Name:SOUTHWEST HOLISTIC CHIROPRACTIC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTESI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:815-464-9060
Mailing Address - Street 1:450 N LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1328
Mailing Address - Country:US
Mailing Address - Phone:815-464-9060
Mailing Address - Fax:
Practice Address - Street 1:450 N LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1328
Practice Address - Country:US
Practice Address - Phone:815-464-9060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008223111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09921980OtherBLUECROSS/SHIELD ID
ILU70599Medicare UPIN
IL09921980OtherBLUECROSS/SHIELD ID