Provider Demographics
NPI:1508818923
Name:MINOR CHIROPRACTIC HEALTH CENTER PC
Entity Type:Organization
Organization Name:MINOR CHIROPRACTIC HEALTH CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-467-5156
Mailing Address - Street 1:25520 S PHEASANT LN
Mailing Address - Street 2:UNIT G
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-8805
Mailing Address - Country:US
Mailing Address - Phone:815-467-5156
Mailing Address - Fax:815-467-8566
Practice Address - Street 1:25520 S PHEASANT LN
Practice Address - Street 2:UNIT G
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-8805
Practice Address - Country:US
Practice Address - Phone:815-467-5156
Practice Address - Fax:815-467-8566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID #