Provider Demographics
NPI:1275713281
Name:ELIXIR CHIROPRACTIC CARE CENTRE, PC
Entity Type:Organization
Organization Name:ELIXIR CHIROPRACTIC CARE CENTRE, PC
Other - Org Name:ELIXIR WELLNESS CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTIKIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-490-7000
Mailing Address - Street 1:1701 E WOODFIELD RD
Mailing Address - Street 2:SUITE 640
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5905
Mailing Address - Country:US
Mailing Address - Phone:847-490-7000
Mailing Address - Fax:312-635-0732
Practice Address - Street 1:1701 E WOODFIELD RD
Practice Address - Street 2:SUITE 640
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5131
Practice Address - Country:US
Practice Address - Phone:847-490-7000
Practice Address - Fax:312-635-0732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207428Medicare PIN