Provider Demographics
NPI:1194833616
Name:WICKER PARK CHIROPRACTIC HEALTH
Entity Type:Organization
Organization Name:WICKER PARK CHIROPRACTIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-276-7300
Mailing Address - Street 1:2300 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5659
Mailing Address - Country:US
Mailing Address - Phone:773-276-7300
Mailing Address - Fax:773-276-7333
Practice Address - Street 1:2300 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-5659
Practice Address - Country:US
Practice Address - Phone:773-276-7300
Practice Address - Fax:773-276-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty