Provider Demographics
NPI:1598055808
Name:CHERNIAK FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:CHERNIAK FAMILY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHRIOPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHERNIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:815-568-2815
Mailing Address - Street 1:203 W PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:IL
Mailing Address - Zip Code:60152-2136
Mailing Address - Country:US
Mailing Address - Phone:815-568-2815
Mailing Address - Fax:815-568-9584
Practice Address - Street 1:203 W PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:IL
Practice Address - Zip Code:60152-2136
Practice Address - Country:US
Practice Address - Phone:815-568-2815
Practice Address - Fax:815-568-9584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008504111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL589810Medicare PIN
ILU81238Medicare UPIN