Provider Demographics
NPI:1568097442
Name:TLC CHIROPRACTIC, SC
Entity Type:Organization
Organization Name:TLC CHIROPRACTIC, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PISHOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:224-678-7334
Mailing Address - Street 1:14 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-1008
Mailing Address - Country:US
Mailing Address - Phone:224-678-7334
Mailing Address - Fax:224-678-7307
Practice Address - Street 1:14 MILLER RD
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-1008
Practice Address - Country:US
Practice Address - Phone:224-678-7334
Practice Address - Fax:224-678-7307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038013152OtherLICENSED CHIROPRACTIC PHYSICIAN
IL042620798OtherREGISTERED MEDICAL CORPORATION