Provider Demographics
NPI:1255465522
Name:LINDSEY CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:LINDSEY CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-487-1111
Mailing Address - Street 1:PO BOX 120
Mailing Address - Street 2:
Mailing Address - City:ISLAND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60042-0120
Mailing Address - Country:US
Mailing Address - Phone:847-487-1111
Mailing Address - Fax:847-487-1164
Practice Address - Street 1:28070 RT. 176
Practice Address - Street 2:
Practice Address - City:ISLAND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60042-9551
Practice Address - Country:US
Practice Address - Phone:847-487-1111
Practice Address - Fax:847-487-1164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT91222Medicare UPIN
IL916110Medicare ID - Type Unspecified