Provider Demographics
NPI:1598021388
Name:WEST LOOP CHIROPRACTIC & SPORTS INJURY CENTER LTD.
Entity Type:Organization
Organization Name:WEST LOOP CHIROPRACTIC & SPORTS INJURY CENTER LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLENDENIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-346-9355
Mailing Address - Street 1:16 N PEORIA ST
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2609
Mailing Address - Country:US
Mailing Address - Phone:312-346-9355
Mailing Address - Fax:312-346-9356
Practice Address - Street 1:16 N PEORIA ST
Practice Address - Street 2:SUITE 101A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2609
Practice Address - Country:US
Practice Address - Phone:312-346-9355
Practice Address - Fax:312-346-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.008065111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1093789216OtherINDIVIDUAL NPI NUMBER