Provider Demographics
NPI:1467679852
Name:CHIROPRACTIC SPORTS INJURY CENTER
Entity Type:Organization
Organization Name:CHIROPRACTIC SPORTS INJURY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENI
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-236-9355
Mailing Address - Street 1:29 S LA SALLE ST
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-1507
Mailing Address - Country:US
Mailing Address - Phone:312-236-9355
Mailing Address - Fax:312-236-9301
Practice Address - Street 1:29 S LA SALLE ST
Practice Address - Street 2:SUITE 1200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-1507
Practice Address - Country:US
Practice Address - Phone:312-236-9355
Practice Address - Fax:312-236-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty