Provider Demographics
NPI:1467585703
Name:FIMREITE CHIROPRACTIC, S.C.
Entity Type:Organization
Organization Name:FIMREITE CHIROPRACTIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:K
Authorized Official - Last Name:FIMREITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-352-3352
Mailing Address - Street 1:4727 WILLOW SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6140
Mailing Address - Country:US
Mailing Address - Phone:708-352-3352
Mailing Address - Fax:
Practice Address - Street 1:4727 WILLOW SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6140
Practice Address - Country:US
Practice Address - Phone:708-352-3352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632800OtherBCBS
IL203785Medicare PIN
IL01632800OtherBCBS