Provider Demographics
NPI:1578619920
Name:BLUE CHIP CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:BLUE CHIP CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLAIM
Authorized Official - Middle Name:R
Authorized Official - Last Name:VANOSS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:847-985-1980
Mailing Address - Street 1:906 S ROSELLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-3980
Mailing Address - Country:US
Mailing Address - Phone:847-985-1980
Mailing Address - Fax:847-985-1980
Practice Address - Street 1:906 S ROSELLE RD STE A
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-3980
Practice Address - Country:US
Practice Address - Phone:847-985-1980
Practice Address - Fax:847-985-1980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
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