Provider Demographics
NPI:1366646135
Name:CHERNE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CHERNE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM CHERNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-991-5191
Mailing Address - Street 1:1115 W ALGONQUIN RD
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-3577
Mailing Address - Country:US
Mailing Address - Phone:847-854-4889
Mailing Address - Fax:
Practice Address - Street 1:1115 W ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-3577
Practice Address - Country:US
Practice Address - Phone:847-854-4889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty