Provider Demographics
NPI:1407473663
Name:CHAMPION CHIROPRACTIC PC
Entity Type:Organization
Organization Name:CHAMPION CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MUSA
Authorized Official - Middle Name:
Authorized Official - Last Name:AYYAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-520-3852
Mailing Address - Street 1:186 SWALLOW AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1369
Mailing Address - Country:US
Mailing Address - Phone:224-520-3852
Mailing Address - Fax:
Practice Address - Street 1:148 S BLOOMINGDALE RD STE 107E
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1491
Practice Address - Country:US
Practice Address - Phone:224-520-3852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center