Provider Demographics
NPI:1619163383
Name:MELINE CHIROPRACTIC CLINIC,
Entity Type:Organization
Organization Name:MELINE CHIROPRACTIC CLINIC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MELINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-362-3111
Mailing Address - Street 1:1448 S BUTTERFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060
Mailing Address - Country:US
Mailing Address - Phone:847-362-3111
Mailing Address - Fax:847-362-3319
Practice Address - Street 1:1448 S BUTTERFIELD ROAD
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060
Practice Address - Country:US
Practice Address - Phone:847-362-3111
Practice Address - Fax:847-362-3319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
155050550671OtherHUMAN
2560556OtherAETNA
IL4982071OtherBLUE CROSS BLUE SHIELD
IL209974Medicare PIN