Provider Demographics
NPI:1447378880
Name:NORTH SUBURBAN CHIROPRACTIC CLINIC LTD
Entity Type:Organization
Organization Name:NORTH SUBURBAN CHIROPRACTIC CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-243-0355
Mailing Address - Street 1:333 WEST DUNDEE ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-3545
Mailing Address - Country:US
Mailing Address - Phone:847-243-0355
Mailing Address - Fax:847-243-0356
Practice Address - Street 1:333 WEST DUNDEE ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-3545
Practice Address - Country:US
Practice Address - Phone:847-243-0355
Practice Address - Fax:847-243-0356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038009710Medicaid
IL01633770OtherBCBS
IL213205Medicare ID - Type Unspecified
IL01633770OtherBCBS