Provider Demographics
NPI:1417313636
Name:CROSSTOWN CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CROSSTOWN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AHO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-961-8970
Mailing Address - Street 1:3649 N KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4513
Mailing Address - Country:US
Mailing Address - Phone:773-961-8970
Mailing Address - Fax:773-961-8951
Practice Address - Street 1:3649 N KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-4513
Practice Address - Country:US
Practice Address - Phone:773-961-8970
Practice Address - Fax:773-961-8951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011645111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty