Provider Demographics
NPI:1477615185
Name:PLATINUM CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:PLATINUM CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARRELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-448-3624
Mailing Address - Street 1:7003 W 114TH PL
Mailing Address - Street 2:
Mailing Address - City:WORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60482-2042
Mailing Address - Country:US
Mailing Address - Phone:708-448-3624
Mailing Address - Fax:
Practice Address - Street 1:4615 W 103RD ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4718
Practice Address - Country:US
Practice Address - Phone:708-601-7679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-16
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