Provider Demographics
NPI:1437549888
Name:CHIROMEND
Entity Type:Organization
Organization Name:CHIROMEND
Other - Org Name:CHIROMEND P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUBY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-730-3988
Mailing Address - Street 1:1834 GLENVIEW RD
Mailing Address - Street 2:SUITE 2W
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-6921
Mailing Address - Country:US
Mailing Address - Phone:847-730-3988
Mailing Address - Fax:
Practice Address - Street 1:1834 GLENVIEW RD
Practice Address - Street 2:SUITE 2W
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-6921
Practice Address - Country:US
Practice Address - Phone:847-730-3988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty