Provider Demographics
NPI:1467491852
Name:ARLINGTON CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:ARLINGTON CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:T
Authorized Official - Last Name:ANDREOLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-259-4493
Mailing Address - Street 1:1702 W CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1518
Mailing Address - Country:US
Mailing Address - Phone:847-259-4493
Mailing Address - Fax:847-259-2242
Practice Address - Street 1:1702 W CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1518
Practice Address - Country:US
Practice Address - Phone:847-259-4493
Practice Address - Fax:847-259-2242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1616245OtherBLUE CROSS BLUE SHIELD
IL604900Medicare ID - Type Unspecified