Provider Demographics
NPI:1316178536
Name:SKOKIE CHIROPRACTIC & SPORTS INJURY CENTER
Entity Type:Organization
Organization Name:SKOKIE CHIROPRACTIC & SPORTS INJURY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-677-9355
Mailing Address - Street 1:8424 SKOKIE BLVD
Mailing Address - Street 2:STE. 207
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2568
Mailing Address - Country:US
Mailing Address - Phone:847-677-9355
Mailing Address - Fax:
Practice Address - Street 1:8424 SKOKIE BLVD
Practice Address - Street 2:STE. 207
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2568
Practice Address - Country:US
Practice Address - Phone:847-677-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-011357111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty