Provider Demographics
NPI:1437392610
Name:POPP FAMILY CHIROPRACTIC P C
Entity Type:Organization
Organization Name:POPP FAMILY CHIROPRACTIC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/SPOUSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:POPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-922-1883
Mailing Address - Street 1:1938 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1730
Mailing Address - Country:US
Mailing Address - Phone:708-922-1883
Mailing Address - Fax:866-204-8818
Practice Address - Street 1:1938 RIDGE RD
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1730
Practice Address - Country:US
Practice Address - Phone:708-922-1883
Practice Address - Fax:866-204-3818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO038-007440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01626928OtherBLUE CROSS BLUE SHIELD INSURANCE
IL928670Medicare UPIN