Provider Demographics
NPI:1235323395
Name:LAKE ZURICH FAMILY CHIROPRACTIC, LTD
Entity Type:Organization
Organization Name:LAKE ZURICH FAMILY CHIROPRACTIC, LTD
Other - Org Name:HOPE CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAIDE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-540-1439
Mailing Address - Street 1:26 N OLD RAND RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2218
Mailing Address - Country:US
Mailing Address - Phone:847-540-1439
Mailing Address - Fax:847-540-6407
Practice Address - Street 1:26 N OLD RAND RD
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2218
Practice Address - Country:US
Practice Address - Phone:847-540-1439
Practice Address - Fax:847-540-6407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04932265OtherBCBS
IL04932265OtherBCBS