Provider Demographics
NPI:1265864789
Name:CENTER FOR CHIROPRACTIC AND NATURAL MEDICINE SC
Entity Type:Organization
Organization Name:CENTER FOR CHIROPRACTIC AND NATURAL MEDICINE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:OBRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-842-1466
Mailing Address - Street 1:180 S WESTERN AVE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:CARPENTERSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60110-1738
Mailing Address - Country:US
Mailing Address - Phone:630-842-1466
Mailing Address - Fax:888-398-1383
Practice Address - Street 1:1141 E MAIN ST
Practice Address - Street 2:SUITE 213
Practice Address - City:EAST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-2440
Practice Address - Country:US
Practice Address - Phone:630-842-1466
Practice Address - Fax:888-398-1383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009973111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206237OtherMEDICARE ID-TYPE UNSPECIFIED