Provider Demographics
NPI:1275578783
Name:PHELPS CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:PHELPS CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-636-5555
Mailing Address - Street 1:5155 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-6021
Mailing Address - Country:US
Mailing Address - Phone:708-636-5555
Mailing Address - Fax:708-636-5564
Practice Address - Street 1:5155 W 111TH ST
Practice Address - Street 2:
Practice Address - City:ALSIP
Practice Address - State:IL
Practice Address - Zip Code:60803-6021
Practice Address - Country:US
Practice Address - Phone:708-636-5555
Practice Address - Fax:708-636-5564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty