Provider Demographics
NPI:1568760759
Name:GRAUN CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:GRAUN CHIROPRACTIC CLINIC
Other - Org Name:GRAUN NATURAL HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRAUN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-969-4240
Mailing Address - Street 1:6428 S CASS AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-3209
Mailing Address - Country:US
Mailing Address - Phone:630-969-4240
Mailing Address - Fax:630-920-5029
Practice Address - Street 1:6428 S CASS AVE
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-3209
Practice Address - Country:US
Practice Address - Phone:630-969-4240
Practice Address - Fax:630-920-5029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038003884111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL628960Medicare PIN