Provider Demographics
NPI:1568187037
Name:GENESIS POINT SC
Entity Type:Organization
Organization Name:GENESIS POINT SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCLANE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-816-3350
Mailing Address - Street 1:33197 N SEARS BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2177
Mailing Address - Country:US
Mailing Address - Phone:847-370-2177
Mailing Address - Fax:
Practice Address - Street 1:330 BARRON BLVD
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-1640
Practice Address - Country:US
Practice Address - Phone:847-816-3350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty