Provider Demographics
NPI:1497995211
Name:LINCOLN PARK CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:LINCOLN PARK CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARION
Authorized Official - Suffix:
Authorized Official - Credentials:DC, ART
Authorized Official - Phone:248-891-9099
Mailing Address - Street 1:2202 N LINCOLN AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-7170
Mailing Address - Country:US
Mailing Address - Phone:773-248-2790
Mailing Address - Fax:773-248-2058
Practice Address - Street 1:2202 N LINCOLN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-7170
Practice Address - Country:US
Practice Address - Phone:773-248-2790
Practice Address - Fax:773-248-2058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011329111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty