Provider Demographics
NPI:1588811772
Name:CHIROLOGIC SC
Entity Type:Organization
Organization Name:CHIROLOGIC SC
Other - Org Name:CHIROLOGIC ARCH WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:GINZBURG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-913-7844
Mailing Address - Street 1:540 ALLENDALE DR
Mailing Address - Street 2:SUITE 2-E
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-2603
Mailing Address - Country:US
Mailing Address - Phone:847-913-7844
Mailing Address - Fax:847-897-5990
Practice Address - Street 1:540 ALLENDALE DR
Practice Address - Street 2:SUITE 2-E
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-2603
Practice Address - Country:US
Practice Address - Phone:847-913-7844
Practice Address - Fax:847-897-5990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38010137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038010137Medicaid