Provider Demographics
NPI:1356465595
Name:EASTLAKE CHIROPRACTIC & HEALTHCARE CENTER
Entity Type:Organization
Organization Name:EASTLAKE CHIROPRACTIC & HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-383-3900
Mailing Address - Street 1:137 N OAK PARK AVE
Mailing Address - Street 2:STE. #111
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1344
Mailing Address - Country:US
Mailing Address - Phone:708-383-3900
Mailing Address - Fax:708-383-3922
Practice Address - Street 1:137 N OAK PARK AVE
Practice Address - Street 2:STE. #111
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1344
Practice Address - Country:US
Practice Address - Phone:708-383-3900
Practice Address - Fax:708-383-3922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty