Provider Demographics
NPI:1457669723
Name:POSITIVE CHANGES CHIROPRACTIC, LTD
Entity Type:Organization
Organization Name:POSITIVE CHANGES CHIROPRACTIC, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRENA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SAYLES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-623-8214
Mailing Address - Street 1:5724B ELEVATOR RD
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-8878
Mailing Address - Country:US
Mailing Address - Phone:815-623-8214
Mailing Address - Fax:815-623-5485
Practice Address - Street 1:5724B ELEVATOR RD
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-8878
Practice Address - Country:US
Practice Address - Phone:815-623-8214
Practice Address - Fax:815-623-5485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009552261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty