Provider Demographics
NPI:1356864920
Name:BACK AND NECK RELIEF CENTER OF IL INC.
Entity Type:Organization
Organization Name:BACK AND NECK RELIEF CENTER OF IL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAJDUK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:224-817-2273
Mailing Address - Street 1:1500 SHERMER RD STE 1SE
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-5343
Mailing Address - Country:US
Mailing Address - Phone:224-817-2273
Mailing Address - Fax:
Practice Address - Street 1:1500 SHERMER RD STE 1SE
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-5343
Practice Address - Country:US
Practice Address - Phone:224-817-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0380099615111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty