Provider Demographics
NPI:1235331646
Name:CASTLE CHIROPRACTIC, LTD.
Entity Type:Organization
Organization Name:CASTLE CHIROPRACTIC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:CASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-202-7860
Mailing Address - Street 1:1885 HICKS RD
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-1215
Mailing Address - Country:US
Mailing Address - Phone:847-202-7860
Mailing Address - Fax:847-202-7864
Practice Address - Street 1:1885 HICKS RD
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-1215
Practice Address - Country:US
Practice Address - Phone:847-202-7860
Practice Address - Fax:847-202-7864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL672407OtherACN
IL7166696OtherAETNA
IL1634260OtherBLUE CROSS BLUE SHEILD
IL9414719OtherPHCS
ILK06917Medicare ID - Type Unspecified